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Диагностика и ведение пациентов с феохромоцитомой/параганглиомой. Консенсус экспертов Российского медицинского общества по артериальной гипертонии и междисциплинарной группы по диагностике и лечению нейроэндокринных опухолей
Диагностика и ведение пациентов с феохромоцитомой/параганглиомой. Консенсус экспертов Российского медицинского общества по артериальной гипертонии и междисциплинарной группы по диагностике и лечению нейроэндокринных опухолей
Блинова Н.В., Иловайская И.А., Чихладзе Н.М., Луговская А.Ю., Бритвин Т.А., Гуревич Л.Е., Нефедова Л.Н., Шикина В.Е., Чазова И.Е. Диагностика и ведение пациентов с феохромоцитомой/параганглиомой. Консенсус экспертов Российского медицинского общества по артериальной гипертонии и междисциплинарной группы по диагностике и лечению нейроэндокринных опухолей. Терапевтический архив. 2024;96(7):645–658. DOI: 10.26442/00403660.2024.07.202779
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
DOI: 10.26442/00403660.2024.07.202779
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
________________________________________________
DOI: 10.26442/00403660.2024.07.202779
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Понимание природы катехоламин-секретирующих опухолей существенно изменилось в последние годы, что отразилось и на терминологии, и на классификации. Феохромоцитома/параганглиома (ФХЦ/ПГ) является редкой нейроэндокринной опухолью из хромаффинной ткани, продуцирующей и секретирующей катехоламины. Частота развития ФХЦ/ПГ относительно невелика и составляет 2–8 случаев на 1 млн населения в год, среди пациентов с артериальной гипертонией их распространенность – 0,2–0,6%. Однако несвоевременно диагностированные случаи ФХЦ/ПГ сопряжены с высоким риском развития сердечно-сосудистых осложнений и высоким уровнем смертности. В консенсусе представлены клинические проявления течения заболевания с акцентом на течение артериальной гипертонии как наиболее часто встречающегося симптома при ФХЦ/ПГ; рассматриваются современные представления об особенностях диагностики, аспектах предоперационной подготовки, лечении и последующем наблюдении пациентов с ФХЦ/ПГ.
Ключевые слова: феохромоцитома, параганглиома, метанефрины, хромогранин А, резистентная артериальная гипертония, синдром такоцубо, метастатические опухоли
Keywords: pheochromocytoma, paraganglioma, metanephrins, chromogranin A, resistant arterial hypertension, takotsubo syndrome, metastatic tumors
Ключевые слова: феохромоцитома, параганглиома, метанефрины, хромогранин А, резистентная артериальная гипертония, синдром такоцубо, метастатические опухоли
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Keywords: pheochromocytoma, paraganglioma, metanephrins, chromogranin A, resistant arterial hypertension, takotsubo syndrome, metastatic tumors
Полный текст
Список литературы
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80. Mei L, Khurana A, Al-Juhaishi T, et al. Prognostic factors of malignant pheochromocytoma and paraganglioma: a combined SEER and TCGA Databases Review. HormMetab Res. 2019;51:451-7. DOI:10.1055/a-0851-3275
81. Wang K, Crona J, Beuschlein F, et al. Targeted Therapies in Pheochromocytoma and Paraganglioma. J Clin Endocrinol Metab. 2022;107(11):2963-72. DOI:10.1210/clinem/dgac471
2. Mete O, Asa SL, Gill AJ, et al. Overview of the 2022 WHO Classification of Paragangliomas and Pheochromocytomas. Endocr Pathol. 2022;33:90-114.
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3. Calissendorff J, Juhlin CC, Bancos I, et al. Pheochromocytomas and Abdominal Paragangliomas: A Practical Guidance. Cancers (Basel). 2022;14(4):917. DOI:10.3390/cancers14040917
4. Lenders JWM, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. DOI:10.1210/jc.2014-1498
5. Santos JRU, Brofferio A, Viana B, et al. Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease? Horm Metab. Res. 2019;51:458-69. DOI:10.1055/a-0669-9556
6. Lo CY, Lam KY, Wat MS, et al. Adrenal pheochromocytoma remains a frequently overlooked diagnosis. Am J Surg. 2000;179:212-5. DOI:10.1016/S0002-9610(00)00296-8
7. Khorram-Manesh A, Ahlman H, Nilsson O, et al. Mortality associated with pheochromocytoma in a large Swedish cohort. Eur J Surg Oncol. 2004;30:556-9. DOI:10.1016/j.ejso.2004.03.006
8. Amar L, Servais A, Gimenez-Roqueplo AP, et al. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab. 2005;90:2110-6. DOI:10.1210/jc.2004-1398
9. Lenders JWM, Kerstens MN, Amar L, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020;38(8):1443-56. DOI:10.1097/HJH.0000000000002438
10. Falhammar H, Kjellman M, Calissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018;7(1):186-92. DOI:10.1530/EC-17-0321
11. Chazova IE, Chikhladze NM, Blinova NV, et al. Eurasian clinical guidelines for the diagnosis and treatment of secondary (symptomatic) forms of arterial hypertension (2022). Eurasian Heart Journal. 2023;1:6-65 (in Russian). DOI:10.38109/2225-1685-2023-1-6-65
12. Fishbein L, Del Rivero J, Else T, et al. The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma. Pancreas. 2021;50(4):469-93. DOI:10.1097/MPA.0000000000001792
13. Geroula A, Deutschbein T, Langton K, et al. Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion. Eur J Endocrinol. 2019;181(4):409-20. DOI:10.1530/EJE-19-0159
14. Stolk RF, Bakx C, Mulder J, et al. Is the excess cardiovascular morbidity in pheochromocytoma related to blood pressure or to catecholamines? J Clin Endocrinol Metab. 2013;98(3):1100-6. DOI:10.1210/jc.2012-3669
15. Soltani A, Pourian M, Davani BM. Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2015;15:6. DOI:10.1186/s40200-016-0226-x
16. King KS, Darmani NA, Hughes MS, et al. Exercise-induced nausea and vomiting: another sign and symptom of pheochromocytoma and paraganglioma. Endocrine.
2010;37(3):403-7. DOI:10.1007/s12020-010-9319-3
17. La Batide-Alanore A, Chatellier G, Plouin PF. Diabetes as a marker of pheochromocytoma in hypertensive patients. J Hypertens. 2003;21(9):1703-7.
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18. An Y, Reimann M, Masjkur J, et al. Adrenomedullary function, obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours. Int J Obes (Lond). 2019;43(2):263-75. DOI:10.1038/s41366-018-0054-9
19. Ebbehoj A, Stochholm K, Jacobsen SF, et al. Incidence and Clinical Presentation of Pheochromocytoma and Sympathetic Paraganglioma: A Population-based Study. J Clin Endocrinol Metab. 2021;106:e2251-61. DOI:10.1210/clinem/dgaa965
20. Manger W, Gifford RW. Clinical and Experimental Pheochromocytoma. Second Edition Blackwell Science. Cambridge, 1996.
21. Bravo E, Tarazi R, Fouad F, et al. Blood pressure regulation in pheochromocytoma. Hypertension. 1982;4(3):193-9. DOI:10.1161/01.HYP.4.3_Pt_2.193
22. Streeten DHP, Anderson GH. Mechanisms of orthostatic hypotension and tachycardia in patients with pheochromocytoma. Am J Hypertens. 1996;9(8):760-9.
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23. Aksenova AV, Sivakova OA, Blinova NV, et al. Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management. Terapevticheskii Arkhiv (Ter. Arkh). 2021;93(9):1018-102 (in Russian). DOI:10.26442/00403660.2021.09.201007
24. Zuber SM, Kantorovich V, Pacak K. Hypertension in pheochromocytoma: characteristics and treatment. Endocrinol Metab Clin North Am. 2011;40(2):295-311. DOI:10.1016/j.ecl.2011.02.002
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75. Weismann D, Liu D, Bergen T, et al. Hypertension and hypertensive cardiomyopathy in patients with a relapse-free history of phaeochromocytoma. Clin Endocrinol.
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77. De Filpo G, Cantini G, Rastrelli G, et al. Management and outcome of metastatic pheochromocytomas/paragangliomas: a monocentric experience. J Endocrinol Invest. 2022;45(1):149-57. DOI:10.1007/s40618-021-01629-x
78. Yamazaki Y, Gao X, Pecori A, et al. Recent Advances in Histopathological and Molecular Diagnosis in Pheochromocytoma and Paraganglioma: Challenges for Predicting Metastasis in Individual Patients. Front Endocrinol (Lausanne). 2020;11:587769. DOI:10.3389/fendo.2020.587769
79. Guilmette J, Sadow PM. A Guide to Pheochromocytomas and Paragangliomas. Surg Pathol Clin. 2019;12(4):951-65. DOI:10.1016/j.path.2019.08.009
80. Mei L, Khurana A, Al-Juhaishi T, et al. Prognostic factors of malignant pheochromocytoma and paraganglioma: a combined SEER and TCGA Databases Review. HormMetab Res. 2019;51:451-7. DOI:10.1055/a-0851-3275
81. Wang K, Crona J, Beuschlein F, et al. Targeted Therapies in Pheochromocytoma and Paraganglioma. J Clin Endocrinol Metab. 2022;107(11):2963-72. DOI:10.1210/clinem/dgac471
2. Mete O, Asa SL, Gill AJ, et al. Overview of the 2022 WHO Classification of Paragangliomas and Pheochromocytomas. Endocr Pathol. 2022;33:90-114.
DOI:10.1007/s12022-022-09704-6
3. Calissendorff J, Juhlin CC, Bancos I, et al. Pheochromocytomas and Abdominal Paragangliomas: A Practical Guidance. Cancers (Basel). 2022;14(4):917. DOI:10.3390/cancers14040917
4. Lenders JWM, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. DOI:10.1210/jc.2014-1498
5. Santos JRU, Brofferio A, Viana B, et al. Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease? Horm Metab. Res. 2019;51:458-69. DOI:10.1055/a-0669-9556
6. Lo CY, Lam KY, Wat MS, et al. Adrenal pheochromocytoma remains a frequently overlooked diagnosis. Am J Surg. 2000;179:212-5. DOI:10.1016/S0002-9610(00)00296-8
7. Khorram-Manesh A, Ahlman H, Nilsson O, et al. Mortality associated with pheochromocytoma in a large Swedish cohort. Eur J Surg Oncol. 2004;30:556-9. DOI:10.1016/j.ejso.2004.03.006
8. Amar L, Servais A, Gimenez-Roqueplo AP, et al. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab. 2005;90:2110-6. DOI:10.1210/jc.2004-1398
9. Lenders JWM, Kerstens MN, Amar L, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020;38(8):1443-56. DOI:10.1097/HJH.0000000000002438
10. Falhammar H, Kjellman M, Calissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018;7(1):186-92. DOI:10.1530/EC-17-0321
11. Чазова И.Е., Чихладзе Н.М., Блинова Н.В., и др. Евразийские клинические рекомендации по диагностике и лечению вторичных (симптоматических) форм артериальной гипертонии (2022). Евразийский Кардиологический Журнал. 2023;1:6-65 [Chazova IE, Chikhladze NM, Blinova NV, et al. Eurasian clinical guidelines for the diagnosis and treatment of secondary (symptomatic) forms of arterial hypertension (2022). Eurasian Heart Journal. 2023;1:6-65 (in Russian)]. DOI:10.38109/2225-1685-2023-1-6-65
12. Fishbein L, Del Rivero J, Else T, et al. The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma. Pancreas. 2021;50(4):469-93. DOI:10.1097/MPA.0000000000001792
13. Geroula A, Deutschbein T, Langton K, et al. Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion. Eur J Endocrinol. 2019;181(4):409-20. DOI:10.1530/EJE-19-0159
14. Stolk RF, Bakx C, Mulder J, et al. Is the excess cardiovascular morbidity in pheochromocytoma related to blood pressure or to catecholamines? J Clin Endocrinol Metab. 2013;98(3):1100-6. DOI:10.1210/jc.2012-3669
15. Soltani A, Pourian M, Davani BM. Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2015;15:6. DOI:10.1186/s40200-016-0226-x
16. King KS, Darmani NA, Hughes MS, et al. Exercise-induced nausea and vomiting: another sign and symptom of pheochromocytoma and paraganglioma. Endocrine.
2010;37(3):403-7. DOI:10.1007/s12020-010-9319-3
17. La Batide-Alanore A, Chatellier G, Plouin PF. Diabetes as a marker of pheochromocytoma in hypertensive patients. J Hypertens. 2003;21(9):1703-7.
DOI:10.1097/00004872-200309000-00020
18. An Y, Reimann M, Masjkur J, et al. Adrenomedullary function, obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours. Int J Obes (Lond). 2019;43(2):263-75. DOI:10.1038/s41366-018-0054-9
19. Ebbehoj A, Stochholm K, Jacobsen SF, et al. Incidence and Clinical Presentation of Pheochromocytoma and Sympathetic Paraganglioma: A Population-based Study. J Clin Endocrinol Metab. 2021;106:e2251-61. DOI:10.1210/clinem/dgaa965
20. Manger W, Gifford RW. Clinical and Experimental Pheochromocytoma. Second Edition Blackwell Science. Cambridge, 1996.
21. Bravo E, Tarazi R, Fouad F, et al. Blood pressure regulation in pheochromocytoma. Hypertension. 1982;4(3):193-9. DOI:10.1161/01.HYP.4.3_Pt_2.193
22. Streeten DHP, Anderson GH. Mechanisms of orthostatic hypotension and tachycardia in patients with pheochromocytoma. Am J Hypertens. 1996;9(8):760-9.
DOI:10.1016/0895-7061(96)00057-X
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24. Zuber SM, Kantorovich V, Pacak K. Hypertension in pheochromocytoma: characteristics and treatment. Endocrinol Metab Clin North Am. 2011;40(2):295-311. DOI:10.1016/j.ecl.2011.02.002
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39. Bokuda K, Yatabe M, Seki Y, Ichihara A. Clinical factors affecting spot urine fractionated metanephrines in patients suspected pheochromocytoma/paraganglioma. Hypertens Res. 2020;43(6):543-9. DOI:10.1038/s41440-020-0406-4
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Авторы
Н.В. Блинова*1, И.А. Иловайская2, Н.М. Чихладзе1, А.Ю. Луговская2, Т.А. Бритвин2, Л.Е. Гуревич2, Л.Н. Нефедова3, В.Е. Шикина2, И.Е. Чазова1
1ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия;
2ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Россия;
3ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия
*nat-cardio1@yandex.ru
1Chazov National Medical Research Center of Cardiology, Moscow, Russia;
2Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia;
3Lomonosov Moscow State University, Moscow, Russia
*nat-cardio1@yandex.ru
1ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия;
2ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Россия;
3ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия
*nat-cardio1@yandex.ru
________________________________________________
1Chazov National Medical Research Center of Cardiology, Moscow, Russia;
2Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia;
3Lomonosov Moscow State University, Moscow, Russia
*nat-cardio1@yandex.ru
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