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2010, Número 3

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Rev Mex Cardiol 2010; 21 (3)


Feocromocitoma: Diagnóstico y tratamiento

Sánchez TRA

Idioma: Español
Referencias bibliográficas: 66
Paginas: 124-137
Archivo PDF: 430.19 Kb.


RESUMEN

Los feocromocitomas son neoplasias que se originan a partir de células cromafines, siendo su principal localización intraadrenal. A nivel extraadrenal se conocen también como paragangliomas que son de 3 tipos: 1, 3 y 4, y se deben a mutaciones génicas que codifican para las subunidades B, C y D de la succinato deshidrogenasa, enzima mitocondrial que interviene en el ciclo de Krebs. En la enfermedad de von Hippel-Lindau, neoplasia endocrina múltiple tipos 2A y 2B y neurofibromatosis tipo 1, el feocromocitoma es relativamente frecuente. El estudio de elección para el diagnóstico del feocromocitoma es la cuantificación de metanefrinas fraccionadas libres en el plasma: normetanefrina y metanefrina. Los estudios de localización implican cuatro modalidades, dos estudios anatómicos: Tomografía axial computada (TAC) y resonancia magnética (RM) y dos funcionales: Tomografía de emisión de positrones con fluoro18 desoxiglucosa ([18FDG] -PET y gammagrafía con meta yodo benzil guanidina marcada con yodo123 ([I123] – MIBG). Una vez confirmado y localizado, se procede al bloqueo α-adrenérgico en primer lugar y después al bloqueo β-adrenérgico. Controlada la hipertensión arterial y comorbilidades asociadas, se procede a su resección quirúrgica. Actualmente existe una predilección por el abordaje laparoscópico retroperitoneal. Diez días después, se realiza la determinación de metanefrinas libres en plasma, si es negativa, debe continuarse su vigilancia en forma indefinida dado el alto índice de recurrencia. Si es positiva, debe practicarse un [I123]–MIBG en búsqueda de metástasis. Hasta el momento no hay un estudio histopatológico que haga la diferencia entre feocromocitoma maligno y benigno.


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