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Anaphylaxis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Plasma free metanephrine and urinary vanillylmandelic acid level measurements may be considered to rule-out pheochromocytoma, serum serotonin and urinary 5-hydroxyindoleacetic acid may be evaluated to rule-out carcinoid syndrome and vasointestinal hormonal polypeptide (VIP) panel may be measured to rule-out VIP secreting tumors (Lieberman and Blaiss 2002).
The Adrenal Glands
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The diagnosis is usually made biochemically by measuring the vanillylmandelic acid (VMA) and metanephrines in a 24 hr urine collection. The exact measurement of plasma and urinary catecholamines is the most sensitive and accurate biochemical method of diagnosis.6 Once a positive biochemical diagnosis is established, adrenergic blockade should be initiated before any form of localization studies is undertaken. Alpha-adrenergic blockade using Dibenzyline® is initiated on a low dose of 10 mg twice daily and increased slowly by 10 to 20 mg/day to a total dose of 300 mg/day. However, occasionally, some tumors secrete sufficient adrenaline to produce beta-adrenergic effects. Therefore, in addition to the alpha blockades, beta blockers may have to be added. When the patient is stable, then the test for localization can be initiated.
Diseases of the adrenal gland
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Elevated 24-hour urinary metanephrines: Total metanephrinesVanillylmandelic acid (VMA).
Synchronous Hepatoblastoma and Neuroblastoma in Two Chinese Infants
Published in Fetal and Pediatric Pathology, 2023
Bo Shao, Yi-zhen Wang, Yuan Fang, Jing Chu, Lian Chen, Le-Jian He
Case 1: A ten-month-old boy presented with a 10 day history of increasing abdominal circumference which led to the discovery of an occupying lesion in the liver by abdominal ultrasound. There was no significant history or family history. Physical examination showed the patient had an extensive palpable epigastric mass, approximately 10.0 cm × 10.0 cm × 2.0 cm, with clear boundary, poor mobility, and no tenderness. The CT (Fig. 1A) scan revealed a large solid mass of the right hepatic lobe measuring 10.5 cm × 8.2 cm × 7.5 cm, with uneven density (Fig. 1B). Mediastinum window displayed a mass in the right paraspinal region with soft tissue density measuring 2.2 cm × 1.6 cm × 1.0 cm, with spotty high-density opacities inside, and the mass enhanced slightly after contrast administration (Fig. 1C). The liver mass was considered as a possible HBL, while the mediastinal lesion was considered as a metastasis or neurogenic tumor. Blood tests showed the initial α-fetoprotein (AFP) level was 86,226.20 ng/mL (reference ranges: 0–8.0 ng/mL). Urinalysis tests showed the urine vanillylmandelic acid (VMA) level was 2.46 mg/24 h (reference range 0–35 mg/24 h). The patient underwent radical resection of the liver tumor and the mediastinal tumor. Two cycles of carboplatin and doxorubicin and three cycles of cisplatin and doxorubicin were given after surgery. The patient had no recurrences/relapses or metastasis during 36 months follow-up after operation.
Urine catecholamines in children with severe Enterovirus A71 infection: comparison with paediatric septic shock
Published in Biomarkers, 2019
Sheng-Ling Jan, Ming-Chih Lin, Sheng-Ching Chan, Hsiu-Fen Lee, Po-Yen Chen, Fang-Liang Huang
Urine samples were collected for 24 h using a urinary catheter with a urine drainage bag or disposable paediatric urine bag within 24 h of diagnosis of septic shock or severe EV-A71 infection stage 2 or 4 for determination of urine catecholamine concentrations soon after obtaining informed consent. Aliquots were stored at 4 °C after urine sample collection, acidified with concentrated hydrochloric acid for adequate acidity (pH 2–4) and the samples were protected from light. All acidified samples were kept at −20 °C until analysis. If 24 h urinary collection was incomplete due to inotropic therapy in critical patients, untimed urine was collected for analysis before inotrope administration. Epi, NE, dopamine (DA) and vanillylmandelic acid (VMA) in urine were measured by high-performance liquid chromatography coupled with electrochemical detection using a commercially available method (Bio-Rad Laboratories, Milan, Italy). All urine samples were assayed in duplicate and values were retained if they were within 10% of each other. Urinary creatinine concentration was measured for each urine sample. Urine catecholamine and VMA concentrations were corrected for the corresponding urine creatinine concentration and expressed as a ratio to creatinine concentration (ug/gCr for catecholamines and mg/gCr for VMA).
Incidental neuroblastoma with bilateral retinoblastoma: what are the chances?
Published in Ophthalmic Genetics, 2018
Kelsey Roelofs, Furqan Shaikh, William Astle, Brenda L. Gallie, Sameh E. Soliman
On staging MRI of the orbit and brain, there was no evidence of optic nerve involvement, extraocular spread, or pineal gland or suprasellar lesions. However, subtle bilateral leptomeningeal enhancement of questionable significance within the parieto-occipital lobes was noticed, prompting proceeding to whole body MRI, to rule out metastatic disease. Whole body MRI and abdominal ultrasonography identified a retroperitoneal midline mass (Figure 1), partially encircling the aorta. Laparoscopic biopsy confirmed the diagnosis of localized neuroblastoma, with favorable histology, and no MYCN amplification. There was no family history of neuroblastoma. Lumbar puncture and bone marrow biopsy were negative for malignancy. Urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels were slightly elevated. The neuroblastoma was considered “low risk” that did not necessarily require systemic chemotherapy.