FACTORS ASSOCIATED WITH DYSGLYCEMIA AND ITS POST-SURGICAL RESOLUTION IN PATIENTS WITH PHEOCHROMOCYTOMAS AND PARAGANGLIOMAS

Abstract

Objective: Pheochromocytomas and paragangliomas (PPGLs) are a group of rare neuroendocrine tumors. Dysglycemia has been observed in patients with PPGLs in some small case series. However, few large studies, and none in China, have described the outcomes of dysglycemia after resection, and the factors associated with the development and resolution of dysglycemia in patients with PPGLs. Design and method: We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2018 and June 2020. Clinical characteristics were compared between patients with and without dysglycemia. Multivariable logistic regression analysis was used to identify independent predictors and the receiver operating characteristic curves was used to evaluate the diagnostic performance of the variables. Results: Among 163 patients in this study, 47.9% had preoperative dysglycemia. Patients with dysglycemia were older at diagnosis and have a higher proportion of hypertension. The white blood cell count and 24-hour urinary epinephrine (24hU-E) concentration were higher in patients with dysglycemia. Multivariable logistic regression analysis showed that age [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.011–1.070; p = 0.006], hypertension (OR, 3.318; 95% CI, 1.375 – 8.009; p = 0.008), and 24hU-E concentration (OR, 1.013; 95% CI, 1.005 –1.022; p = 0.016) were independent predictors of preoperative dysglycemia. Taking age, hypertension and 24hU-E into account in the same model, the area under the receiver operating characteristic curve of the model for predicting preoperative dysglycemia was 0.737. The proportion of patients with dysglycemia was significantly decreased after surgery (p < 0.001) and patients with postoperative dysglycemia in remission had larger preoperative tumor diameters (p = 0.005). Conclusions: Dysglycemia affects almost half of patients with PPGLs. Age, hypertension, and 24hU-E concentration are predictors of preoperative dysglycemia. Removal of PPGLs can improve dysglycemia in most patients, and the postoperative remission of dysglycemia is associated with the preoperative tumor diameter. These results are of great importance for risk assessment and selection of optimal therapy of dysglycemia in patients with PPGLs.