MP12-05 IMPACT OF ELEVATED URINARY METANEPHRINE/NORMETANEPHRINE AND IMPAIRED GLUCOSE TOLERANCE TEST ON THE DEVELOPMENT OF HYPOGLYCEMIA FOLLOWING REMOVAL OF PHEOCHROMOCYTOMA

Abstract

You have accessJournal of UrologyAdrenal1 Apr 2016MP12-05 IMPACT OF ELEVATED URINARY METANEPHRINE/NORMETANEPHRINE AND IMPAIRED GLUCOSE TOLERANCE TEST ON THE DEVELOPMENT OF HYPOGLYCEMIA FOLLOWING REMOVAL OF PHEOCHROMOCYTOMA Yuma Waseda, Shingo Moriyama, Takayuki Nakayama, Hajime Tanaka, Masaharu Inoue, Masaya Ito, Yoshinobu Komai, Soichiro Yoshida, Naoko Kawamura, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Yasuhisa Fujii, and Kazunori Kihara Yuma WasedaYuma Waseda More articles by this author , Shingo MoriyamaShingo Moriyama More articles by this author , Takayuki NakayamaTakayuki Nakayama More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Masaharu InoueMasaharu Inoue More articles by this author , Masaya ItoMasaya Ito More articles by this author , Yoshinobu KomaiYoshinobu Komai More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Naoko KawamuraNaoko Kawamura More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2445AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The removal of pheochromocytoma can cause several life-threatening complications. Hypoglycemia, as well as hypotensive shock, is associated with the adrenergic actions of increased plasma catecholamines and their sudden loss after tumor removal. While perioperative blood pressure control has been thoroughly investigated, few studies have examined post-excisional severe hypoglycemia. The aim of this study is to investigate preoperative risk factors in the development of post-excisional hypoglycemia. METHODS This study included 35 patients who underwent surgical removal of pheochromocytoma with perioperative glucose monitoring until 20 hr after tumor removal. Preoperative variables included age, tumor size, urinary catecholamine levels, degree of glucose tolerance, and insulinogenic index. Diabetes mellitus (DM), prediabetes (PD; impaired glucose tolerance or impaired fasting glucose) and normal glucose tolerance (NGT) were diagnosed based on the World Health Organization diabetes diagnostic criteria. Post-excisional hypoglycemia was defined as a plasma glucose level of less than 73 mg/dl or of the necessity of glucose administration against a sudden drop in plasma glucose level. We analyzed the relationships between these preoperative parameters and the development of post-excisional hypoglycemia. RESULTS Post-excisional hypoglycemia occurred in 18 patients (51%). Plasma glucose monitoring revealed a median interval between tumor removal and development of hypoglycemia of 150 min (range: 60-300). Six of nine DM patients (67%), nine of 14 PD patients (64%), and three of 12 NGT patients (25%) developed post-excisional hypoglycemia. Multivariate analysis identified two risk factors for the development of post-excisional hypoglycemia:″DM or PD″ (HR 10.2, p = 0.026) and ″elevated urinary metanephrine and/or normetanephrine above ten times the upper reference limit″ (HR 47.9, p = 0.002). Risk stratification enabled us to classify the patients into three subgroups with different incidences of post-excisional hypoglycemia (0%, 29% and 88%, p < 0.001). CONCLUSIONS Patients with elevated urinary metanephrine/normetanephrine above ten times the upper reference limit and/or impairment of glucose tolerance are at high risk for hypoglycemia after removal of pheochromocytoma. Plasma glucose levels should therefore be monitored for at least 5 hr after removal of pheochromocytoma to enable early detection and prompt treatment of this potentially fatal complication. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e127 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yuma Waseda More articles by this author Shingo Moriyama More articles by this author Takayuki Nakayama More articles by this author Hajime Tanaka More articles by this author Masaharu Inoue More articles by this author Masaya Ito More articles by this author Yoshinobu Komai More articles by this author Soichiro Yoshida More articles by this author Naoko Kawamura More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Noboru Numao More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...