Resection Of Paraganglioma Research Articles

Diameter-Based Volumetric Models May Inadequately Calculate Jugular Paraganglioma Volume Following Sub-Total Resection.

As gross total resection of jugular paragangliomas (JPs) may result in cranial nerve deficits, JPs are increasingly managed with subtotal resection (STR) with postoperative radiological monitoring. However, the validity of commonly used diameter-based models that calculate postoperative volume to determine residual tumor growth is dubious. The purpose of this study was to assess the accuracy of these models compared to manual volumetric slice-by-slice segmentation. A senior neuroradiologist measured volumes via slice-by-slice segmentation of JPs pre- and postoperatively from patients who underwent STR from 2007 to 2019. Volumes from three linear-based models were calculated. Models with absolute percent error (APE) > 20% were considered unsatisfactory based on a common volumetric definition for residual growth. Bland-Altman plots were used to evaluate reproducibility, and Wilcoxon matched-pairs signed rank test evaluated model bias. Twenty-one patients were included. Median postoperative APE exceeded the established 20% threshold for each of the volumetric models as cuboidal, ellipsoidal, and spherical model APE were 63%, 28%, and 27%, respectively. The postoperative cuboidal model had significant systematic bias overestimating volume (p = 0.002) whereas the postoperative ellipsoidal and spherical models lacked systematic bias (p = 0.11 and p = 0.82). Cuboidal, ellipsoidal, and spherical models do not provide accurate assessments of postoperative JP tumor volume and may result in salvage therapies that are unnecessary or inappropriately withheld due to inaccurate assessment of residual tumor growth. While more time-consuming, slice-by-slice segmentation by an experienced neuroradiologist provides a substantially more accurate and precise measurement of tumor volume that may optimize clinical management.

Preoperative Alpha-Blocker Therapy in Patients with Missed Preoperative Diagnosis of Extra-Adrenal Retroperitoneal Paraganglioma Undergoing Resection: A Retrospective Study of 167 Cases at a Single Center

Introduction: Preoperative α-adrenergic blockade is thought to decrease perioperative risks and mortality in surgeries for adrenal pheochromocytoma. However, there are limited data on the efficacy of α-blockers in surgeries for retroperitoneal paragangliomas. The aim of this study was to evaluate the effects of the preoperative α-adrenergic blockade on outcomes in patients undergoing surgery for extra-adrenal retroperitoneal paraganglioma. Methods: We searched the clinical database for patients diagnosed with extra-adrenal retroperitoneal paraganglioma by postoperative histopathology in the General Hospital of People’s Liberation Army in China from 2000 to 2017. We compared the preoperative status of patients, preoperative examination, preoperative preparation, intraoperative and postoperative cardiovascular events, intake and output, length of stay in the intensive care unit, length of hospital stays, and short-term outcomes between patients who received preoperative treatment with α-adrenergic blockade and those who did not. Results: Of the 167 patients enrolled in the study, 61 received preoperative α-adrenergic blockade therapy. Intraoperative heart rate elevation and highest heart rate were higher in patients undergoing tumor manipulation with preoperative α-adrenergic blockade than those who did not (p < 0.05). However, there were no significant differences between these 2 groups in terms of intraoperative blood pressure elevation and systolic blood pressure decrease following tumorectomy (p > 0.05). Moreover, there were no significant differences in postoperative complications and outcomes (p > 0.05). Conclusion: Under the current medical practice, resection of extra-adrenal retroperitoneal paraganglioma can be successfully carried out with or without preoperative α-adrenergic blockade.

Preoperative embolization of jugular paraganglioma tumors using particles is safe and effective.

Jugular paragangliomas represent a surgical challenge due to their vascularity and proximity to vital neurovascular structures. Preoperative embolization aids in reducing intraoperative blood loss, transfusion requirements, and improves surgical visualization. Several embolization agents have been used. The aim of this study is to evaluate the safety and efficacy of PVA in pre-operative embolization of jugular paragangliomas. A retrospective review of all patients who underwent jugular paraganglioma resection with pre-operative embolization between 2000 and 2020 was performed. Pre-operative data including baseline patient and tumor characteristics were documented. Outcomes of preoperative embolization including extent of devascularization and post-embolization complications were recorded. Early and long-term postoperative outcomes were reported. Twenty-nine patients met study criteria with a median age of 38 years. Average tumor size was 3.4±1.8 cm. The most commonly encountered arterial feeder was the ascending pharyngeal artery followed by the posterior auricular artery. More than 50% reduction in tumor blush was achieved in 25 patients (86.2%). None of the patients experienced new or worsening cranial neuropathy following embolization. Gross total or Near total resection was achieved in 13 patients (44.8%). A STR or NTR was chosen in these patients to preserve cranial nerve function or large vessel integrity. Average intraoperative estimated blood loss was 888 ml, 9 patients (31%) required intra-operative transfusion of blood products. Extent of resection and post-operative complications did not correlate with extent of devascularization. Pre-operative embolization of jugular paraganglioma tumors with PVA particles is an effective strategy with a high safety profile.

Functional Outcomes Following Delayed Laryngeal Reinnervation Of Patients with Vagal Paralysis After Paraganglioma and Schwannoma Surgery

We present a prospective case series that aimed to report the functional (voice and swallowing) outcomes of delayed laryngeal reinnervation following vagal interruption by resection of vagal paraganglioma and schwannoma. A dedicated, anonymized database was established in 2012 with a minimum eighteen-month follow up set for this report. Internationally validated self- and observer-reported measures were recorded preoperatively and at six, 12 and, 18 months together with demographics, diagnoses, and operative details. A total of eight patients with a median age of 46 (37-54) underwent excision of vagal paraganglioma (five) and schwannoma (three) with few mild complications. Three underwent selective and five non selective reinnervation. Seven out of eight patients underwent synchronous injection medialization. The voice handicap index (VHI-30) improved from a baseline median 83 (range 52-102) to 7.5 (5-58) at 18 months; maximum phonation time improved from median 8 (range 5-15) to 10.5 (8.5-11); voice grade ("G" in grade, roughness, breathiness, asthenia, and strain [GRBAS] scoring) improved from median three (severe impairment, range 0-3) to one (mild impairment, 0-2); Eating Assessment Tool (EAT-10) score improved from median 12 (range 3.5-27) preoperatively to one (0-16); and reflux symptom index (RSI) improved from median 25 (range 17-36) to 7 (0-36). One patient exhibited no discernible reinnervation, while the remainder exhibited good cord bulk and tone, though without purposive abduction. Delayed laryngeal reinnervation for high vagal paralysis is a safe technique associated with good voice and swallowing outcomes by 12-18 months. Potential confounders in this small series and the absence of a control arm both limit conclusions, but this study suggests that further prospective, controlled studies, and/or case registration are merited.

Serendipity and the Second Malignancy: Clear Cell Renal Carcinoma Workup Revealing a Paraaortic Paraganglioma With Post-Operative Vasoplegia

Pheochromocytoma and paraganglioma (PPGL) are neuroendocrine tumors requiring careful pre- and post-operative management to dampen fluctuations in catecholamines. These lesions are not typically biopsied due to risk of catecholamine-induced hemodynamic instability. This case illustrates the importance of considering PPGL in patients without typical symptoms, and highlights challenges with post-operative blood pressure management following use of phenoxybenzamine.A 52 year old man presented with a 40 lb weight loss. PET/CT revealed a right renal mass, enlarged retroperitoneal lymph nodes, and increased uptake in retroperitoneal and paraaortic lesions. Paraaortic lymph node biopsy was consistent with paraganglioma.This finding was unexpected as the patient did not report palpitations, paroxysmal hypertension, or diaphoresis. He had no family history of neuroendocrine tumors. Fortunately, he had no adverse effects during biopsy despite subsequent testing showing elevated plasma metanephrines (271 pg/mL, normal ≤ 57 pg/mL) and normetanephrines (770 pg/mL, normal ≤ 148 pg/mL). I-123 MIBG scan revealed an enlarged left paraaortic mass with increased activity consistent with paraganglioma. He started preoperative alpha blockade with phenoxybenzamine 14 days prior to surgery. Propranolol was added 10 days later to provide combined sympathetic blockade.The patient underwent partial right nephrectomy and resection of the paraaortic mass. Pathology showed renal cell carcinoma (RCC) and paraganglioma, respectively. On post-operative day 1, maintenance fluids were discontinued and he developed palpitations and tachycardia to 140 beats per minute, with blood pressure in the 130s/80s. RCC associated pulmonary embolism, beta-blocker withdrawal, and vasoplegia due to phenoxybenzamine use and paraganglioma resection were considered. The patient was treated with 4 additional liters of normal saline over the next two days to address post-operative vasoplegia, and his tachycardia resolved. Genetic testing for neuroendocrine tumor syndromes including Von Hippel-Lindau (VHL) is ongoing.Clinical Lessons: 1. PPGL should be considered in patients with newly identified intraabdominal masses, even in patients without typical symptoms of catecholamine excess to avoid high risk biopsy. 2. Paraganglioma resection is associated with vasoplegia due to post-operative reduction in circulating catecholamines. 3. The covalent, irreversible alpha antagonist phenoxybenzamine accumulates in adipose tissue, and clinical effects can last up to 7 days after discontinuation. Hypotension can be avoided with aggressive fluid resuscitation. Beta antagonists should be used with caution as they may precipitate hypotension. 4. For patients presenting with paraganglioma and renal cell cancer, genetic syndromes including VHL or RAPTAS etiologies should be considered.

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model.

Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles. This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality. Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated. All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort. The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.

Jugular foramen paragangliomas: preoperative transcatheter particle embolization.

Jugular foramen paragangliomas (JFP) are benign tumors of neural crest origin that are located along the temporal bone in the region of the jugular bulb and middle ear. The optimal management of these lesions includes surgical excision with or without preoperative embolization as well as stereotactic radiotherapy. The use of preoperative embolization in the treatment of JFP has shown great promise to bridge patients to surgery by diminishing complication rates and decreasing intraoperative bleeding. We present three successful polyvinyl alcohol (PVA) particle embolizations of patients presenting with symptomatic JFPs. All patients recovered completely in the short term with no bleeding during or after resection of paragangliomas and they were discharged free of their presenting symptoms. Early clinical and imaging diagnosis followed by adequate treatment including preoperative transcatheter particle embolization and surgical or radiosurgical interventions can lead to excellent outcomes.

Preoperative embolization does not bring advantages in the resection of carotid paragangliomas: a bicentric study

The tumors of the carotid body (TCB) are rare, but require surgical resection given their evolutionary and malignant potential. For some authors, the hypervascularization of the tumor justifies preoperative embolization in order to facilitate the resection and to limit the complications, but this procedure remains discussed. The objective of our study was to evaluate the results of surgical resection with or without preoperative embolization in a bicentric cohort.

Is Preoperative Embolization Necessary for Carotid Paraganglioma Resection: Experience of a Tertiary Center.

This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not. Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted. A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class (r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors (r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury (r = -.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = -.64; P = .000). Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.

Epidural anesthesia and hypotension in pheochromocytoma and paraganglioma.

Postoperative hypotension frequently occurs after resection of pheochromocytoma and/or paraganglioma (PPGLs). Epidural anesthesia (EA) is often used for pain control in open resection of these tumors; one of its side effects is hypotension. Our aim is to determine if EA is associated with an increased risk of postoperative hypotension after open resection of PPGLs. We conducted a retrospective review of patients who underwent open resection of PPGLs at the National Institutes of Health from 2004 to 2019. Clinical and perioperative parameters were analyzed by the use of EA. The primary endpoint was postoperative hypotension. Ninety-seven patients (46 female and 51 male; mean age, 38.5 years) underwent open resection of PPGLs and 69 (71.1%) received EA. Patients with EA had a higher rate beta-blocker use (79.7% vs 57.1%, P = 0.041), metastasis (69.6% vs 39.3%, P = 0.011), and were more frequently hypotensive after surgery (58.8% vs 25.0%, P = 0.003) compared to those without EA. Patients with postoperative hypotension had higher plasma normetanephrines than those without (7.3 fold vs 4.1 fold above the upper limit of normal, P = 0.018). Independent factors associated with postoperative hypotension include the use of beta-blockers (HR = 3.35 (95% CI: 1.16-9.67), P = 0.026) and EA (HR = 3.49 (95% CI: 1.25-9.76), P = 0.017). Data from this retrospective study suggest that, in patients with open resection of PPGLs, EA is an independent risk factor for early postoperative hypotension. Special caution is required in patients on beta-blockade. A prospective evaluation with standardized protocols for the use of EA and management of hemodynamic variability is necessary.

Predictors of hemodynamic instability in patients with pheochromocytoma and paraganglioma.

Background and ObjectivesIntraoperative hemodynamic instability is common in patients with pheochromocytoma and paraganglioma. The aim of this study was to identify the predictive risk factors of intraoperative hemodynamic instability.MethodsA total of 428 patients having elective resection of pheochromocytoma and/or paraganglioma at Peking Union Medical College Hospital between January 2014 and July 2019 were included. The association between preoperative parameters and the incidence of intraoperative hemodynamic instability were evaluated. Binary logistic regression was used to assess the predictive risk factors of hemodynamic instability.ResultsPatients with intraoperative hemodynamic instability were more prone to have elevated levels of norepinephrine and epinephrine. Binary Logistic regression showed the risk factors of hemodynamic instability were tumor size >5.0 cm (odds ratio [OR], 1.889; 95% confidence interval [CI], 1.243‐2.870; P = .003) and five‐fold increases of urine epinephrine (OR, 2.195; 95% CI, 1.242‐3.880; P = .007).ConclusionsIntraoperative hemodynamic instability is common despite adequate preoperative medical treatment. Tumor size and high level of urinary epinephrine are tumor‐related factors for intraoperative hemodynamic instability. Identifying these factors can help clinicians to manage patients more effectively and improve patients' outcomes.

Laparoscopic resection of a ruptured retroperitoneal paraganglioma

Abstract Laparoscopic resection of a retroperitoneal paraganglioma is considered challenging because of variable anatomical presentation and potential vascular injury during surgical manipulation. Due to the rarity of the entity, only a few studies using this technique have been reported. Furthermore, a ruptured paraganglioma which manifests in traumatic retroperitoneal hemorrhage is exceedingly uncommon. Herein, we reported a case of a 12-year-old girl who presented with a ruptured retroperitoneal paraganglioma due to abdominal blunt trauma. Her contrast-enhanced computed tomography scan revealed a retroperitoneal hemorrhage and an abdominal mass of approximately 4 cm in diameter surrounded by the aorta, inferior vena cava, and left renal vein. A preoperative diagnosis of retroperitoneal paraganglioma was made from her 24 hour urinary catecholamine level, a clonidine loading test, and 123I-MIBG scintigraphy and elective laparoscopic resection was performed. Despite of dense peritumoral adhesion, a clear and magnified view of the surgical field and meticulous manipulation of the tumor allowed this laparoscopic resection to be successful, minimally invasive, and safe.

Anaesthetic management of a large paraganglioma resection in a woman with isolated L-looped transposition of the great arteries: a case report

BackgroundReports of anaesthetic management of paraganglioma resection in patients with isolated L-transposition of the great arteries (L-TGA) are rare. We focus on the preoperative evaluation, intraoperative management, and postoperative care of a frail patient with “physiologically corrected” L-TGA for paraganglioma resection.Case presentationWe performed general anaesthesia for a 46-year-old patient with “physiologically corrected” L-TGA undergoing open large retroperitoneal paraganglioma resection. Although the preoperative medical therapy had attained its goals, the patient went through three periods of severe episodic hypertension and tachycardia as tumour manipulation released catecholamines. Goal-directed fluid therapy based on pulse pressure variation (PPV) and point-of-care transesophageal echocardiography (TEE) imaging enabled anaesthesiologists to make rapid judgments and to regulate blood pressure in a timely manner, thereby reducing the risk of heart failure caused by massive rapid fluid bolus therapy. The patient was transferred to the intensive care unit because of intraoperative hemodynamic changes and significant blood loss. Despite transient myocardial injury (elevated troponin I), no lethal arrhythmia or complications occurred perioperatively, and the patient recovered well and was discharged 1 week later.ConclusionsGoal-directed fluid therapy combined with the adoption of TEE could effectively guide fluid administration, which is helpful for anaesthesia management during operation. We recommend the routine use of TEE in such cases.

The “ABC” of anaesthesia for resection of a catecholamine secreting vagal paraganglioma: Adrenergic Blockade Confirmed

The “ABC” of anaesthesia for resection of a catecholamine secreting vagal paraganglioma: Adrenergic Blockade Confirmed

经尿道2 μm激光治疗无症状膀胱副神经节瘤长期随访1例并文献复习

经尿道2 μm激光治疗无症状膀胱副神经节瘤长期随访1例并文献复习

Anesthesia management of cardiac paraganglioma resection by beating-heart surgery

Anesthesia management of cardiac paraganglioma resection by beating-heart surgery

Transient hypotension during endoscopic resection of gangliocytic paraganglioma with ampullary involvement.

Transient hypotension during endoscopic resection of gangliocytic paraganglioma with ampullary involvement.

Resection of Symptomatic ureteric paraganglioma with appendiceal interposition

Abstract We present a rare tumour in an even rarer position requiring a radical excision. The resultant mid ureteric defect was interposed with the novel use of a pedicled appendiceal interposition conduit.

P1.15-06 Resection of Thoracic Paragangliomas: A Multicenter Experience

Paragangliomas are chromaffin cell tumor arising from the sympathetic ganglia. Approximately 2% of paragangliomas occur in the thoracic cavity. Surgical resection is an effective treatment with most cases being curative. Tumor recurrence and long-term prognosis data remain scarce. We described our 14-year experience of complete resections. We analyzed surgical characteristics and outcomes from our multicenter cohort of 17 patients with complete paraganglioma resection. We performed a retrospective review from May 2004 to August 2018 across three institutions. Perioperative data were collected using all available medical records from diagnosis to date. Description of baseline demographics, surgical outcomes, complications and survival rates were included in the analysis. Data are reported as mean ± standard deviation (SD) where applicable. A total of 17 patients underwent resection of thoracic paraganglioma. Baseline demographics, operative characteristics and outcomes are presented in Table 1. Mean age at the time of surgery was 46.8 ± 17.2 with ages ranging from 15 to 76 years. Sixty-five percent of patients were male. Eleven patients (64.7%) had the tumor arising from the left atrium, 3 (17.6%) from the mediastinum, 2 (11.8%) from the aorta, and one (5.9%) from both the left and right atria. Eight (47%) patients underwent cardiac autotransplant technique for a better resection approach. Additionally, 2 patients had a concomitant aortic valve and a pulmonic valve replacement, respectively. Complications included tamponade, right ventricular failure requiring RVAD, left ventricular failure requiring IABP, bi-ventricular failure requiring both RVAD and IABP, junctional bradycardia, tracheostomy, and vocal cord paralysis. Recurrence of the tumor presented in three patients (17.6%). One-year, five-year and ten-year survival was 92.3%, 87.5% and 75%, respectively.Table 1ResultsTotal N=17n (%)Age (Mean, years)*46.8 +/- 17.2Male Gender11 (64.7)Race:Caucasian9 (52.9)African American7 (41.2)Hispanic1 (5.9)Preoperative Chemotherapy1 (5.9)Tumor location:Left atrium11 (64.7)Left and right atrium1 (5.9)Mediastinum3 (17.6)Aorta2 (11.8)Surgical Procedure:Autotransplant8 (47)Valve replacement:- Aortic1 (50)- Pulmonic1 (50)Area of Reconstruction:Left Atrium8 (47)Left and right atrium2 (11.8)Right Ventricle and Pulmonary Artery1 (5.9)Aorta1 (5.9)Left main coronary artery1 (5.9)Postoperative Complications:Tamponade2 (11.8)Right Ventricular Heart Failure (RVAD)1 (5.9)Left Ventricular Heart Failure (IABP)1 (5.9)Bi-ventricular Heart Failure1 (5.9)Junctional Bradycardia1 (5.9)Tracheostomy (ventilator dependence)1 (5.9)Vocal cord paralysis1 (5.9)Postoperative Outcomes:Recurrent tumor3 (17.6)Deceased1 (5.9) Open table in a new tab Thoracic paragangliomas are rare and surgically challenging tumors due to their anatomical proximity with surrounding structures. Complete surgical excision is the elective treatment. Surgical mortality is reasonable for this complex disease and long-term outcomes are favorable in patients with complete resection.

Surgical Resection of Pheochromocytomas and Paragangliomas is Associated with Lower Cholesterol Levels.

Catecholamine excess in patients with pheochromocytomas or paragangliomas (PPGLs) can lead to hypertension, diabetes and hyperlipidemia. The aim was to investigate the prevalence of hyperlipidemia and the effect of surgical resection. One hundred and thirty-two patients with PPGLs underwent an operation at the National Institutes of Health from 2009 to 2016, of which 54 patients met the inclusion criteria. Clinical demographics, BMI, genetic mutations, tumor size, perioperative catecholamine levels and perioperative lipid panels were retrospectively reviewed. Spearman correlation between catecholamines and lipid levels was evaluated. Paired Wilcoxon and paired t test were used to analyze differences in pre- and postoperative lipid levels. Preoperatively, 51 patients (94.4%) had elevated catecholamines, thirteen (24.1%) had elevated total cholesterol (TC) (>200mg/dL), nine (16.6%) had elevated LDL (>130mg/dL) and ten (18.5%) had elevated triglycerides (>150mg/dL). Serum and urinary metanephrine levels were positively associated with TC (r = 0.2792, p = 0.0372 and r = 0.4146, p = 0.0031, respectively) and LDL levels (r = 0.2977, p = 0.0259 and r = 0.4434, p = 0.0014, respectively). Mean TC decreased from 176.4 to 166.3mg/dL (p = 0.0064) and mean HDL decreased from 56.7 to 53.2mg/dL (p = 0.0253) after PPGL resection (median 3.1months (range 1.3-50.2) between lipid panels). Most patients with elevated TC (76.9%) had improvement with mean TC decreasing from 225 to 200.2mg/dL (p = 0.0230). Of patients with elevated LDL, 66.7% had improvement with mean LDL decreasing from 149 to 131.1mg/dL (p = 0.0313). The prevalence of hyperlipidemia in patients with PPGLs is 46%. Future prospective studies are needed to determine whether surgical resection improves TC and/or LDL levels.