PD3-08 IMPACT OF IMPAIRED GLUCOSE TOLERANCE ON THE DEVELOPMENT OF HYPOGLYCEMIA FOLLOWING REMOVAL OF PHEOCHROMOCYTOMA

Abstract

You have accessJournal of UrologyAdrenal1 Apr 2015PD3-08 IMPACT OF IMPAIRED GLUCOSE TOLERANCE ON THE DEVELOPMENT OF HYPOGLYCEMIA FOLLOWING REMOVAL OF PHEOCHROMOCYTOMA Manabu Tatokoro, Yasukazu Nakanishi, Yoshinobu Komai, Yoh Matsuoka, Junichiro Ishioka, Noboru Numao, Takanobu Yoshimoto, Kazutaka Saito, Yasuhisa Fujii, Yoshihiro Ogawa, and Kazunori Kihara Manabu TatokoroManabu Tatokoro More articles by this author , Yasukazu NakanishiYasukazu Nakanishi More articles by this author , Yoshinobu KomaiYoshinobu Komai More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Takanobu YoshimotoTakanobu Yoshimoto More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Yoshihiro OgawaYoshihiro Ogawa More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The resection of pheochromocytoma can cause several life-threatening complications. Although perioperative blood pressure control has been fully investigated, few studies have examined post-excisional severe hypoglycemia. As with hypotensive shock, hypoglycemia is associated with the adrenergic actions of increased plasma catecholamines and their sudden withdrawal after tumor removal. The aim of this study is to predict the development of post-excisional hypoglycemia based on preoperative factors. METHODS This study included 29 patients who underwent surgical removal of pheochromocytoma with perioperative glucose monitoring until 20 h after tumor removal. Preoperative variables included age, tumor size, urinary catecholamine levels, degree of glucose tolerance, and insulinogenic index. Definitions of diabetes mellitus (DM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT) were according to the Japan Diabetes Society criteria. Post-excisional hypoglycemia was defined as a plasma glucose level of less than 73 mg/dl or in the case of glucose administration against a sudden drop in plasma glucose level. We analyzed the relationship of these preoperative parameters and the development of post-excisional hypoglycemia. RESULTS Post-excisional hypoglycemia occurred in 17 of 29 patients (59%) and severe hypoglycemia of less than 50 mg/dl occurred in 3 patients (10%). Plasma glucose monitoring revealed that the development of hypoglycemia occurred 150 min (mean: 60–270 min) after tumor removal. Six of 7 DM patients (86%), 8 of 11 IGT patients (73%), and 3 of 11 NGT patients (27%) developed post-excisional hypoglycemia (p = 0.02). Multivariate analysis demonstrated that “impaired glucose tolerance” (p = 0.023) and “increased urinary metanephrine” (p = 0.010) were independent factors in the development of post-excisional hypoglycemia. CONCLUSIONS Patients with impaired glucose tolerance, regardless of its severity, are at high risk for hypoglycemia after removal of pheochromocytoma. The plasma glucose level should therefore be monitored for at least 5 h after removal of pheochromocytoma to detect hypoglycemia early and to enable prompt treatment of this potentially fatal complication. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e84 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manabu Tatokoro More articles by this author Yasukazu Nakanishi More articles by this author Yoshinobu Komai More articles by this author Yoh Matsuoka More articles by this author Junichiro Ishioka More articles by this author Noboru Numao More articles by this author Takanobu Yoshimoto More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Yoshihiro Ogawa More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...