Removal Of Pheochromocytoma Research Articles

Perioperative hemodynamic management in surgery for phaeochromocytoma: A narrative review

Pheochromocytomas are rare adrenal tumors that produce excessive catecholamines and their surgical removal poses significant risks of intraoperative hemodynamic instability (HI) due to catecholamine release. This review article discusses the perioperative factors that impact hemodynamic lability and its management in patients undergoing surgical removal. A literature review was conducted by searching the electronic databases - Ovid MEDLINE, Embase, and Cochrane Library using appropriate Medical Subject Heading terms and keywords such as phaeochromocytoma, HI, and perioperative hemodynamic monitoring. The advancements in surgical and anesthetic techniques and appropriate preoperative medical optimization have contributed to a significant decrease in mortality rates. However, perioperative HI remains the biggest surgical and anesthetic challenge in treating pheochromocytomas. Patients with larger and more hormonally active tumors are at higher risk for extreme hypertensive episodes during surgery. Preoperative α-blockade, higher phenoxybenzamine doses, and laparoscopic approach improve the outcomes in phaeochromocytoma removal. Anesthetic techniques and drugs used during surgery may help prevent HI, but careful intraoperative management is essential. Perioperative HI can lead to increased surgical blood loss, patient morbidity, and prolonged intensive care unit (ICU) and hospital stay. Therefore, a multidisciplinary approach involving the surgeon, anesthesiologist, and ICU team is essential to ensure optimal perioperative management of patients with pheochromocytoma. Intensive hemodynamic monitoring may be required in the postoperative period to manage hypotension seen after tumor removal. In conclusion, perioperative HI is a significant risk during the surgical removal of pheochromocytomas, even with preoperative pharmacological treatment. Therefore, the use of appropriate preoperative medical optimization, surgical and anesthetic techniques, and careful intraoperative management can significantly improve the outcomes.

Феохромоцитома: особливості гемодинамічного контролю при лапароскопічних адреналектоміях

Мета роботи: упровадження сучасного анестезіологічного менеджменту пацієнтів із феохромоцитомою в умовах спеціалізованого ендокринологічного центру із застосуванням алгоритму етапного періопераційного гемодинамічного контролю. Матеріали і методи. Проведена імплементація анестезіологічного менеджменту в 33 жінок із феохромоцитомою надниркових залоз при хірургічному її видаленні шляхом відеоасистованої лапароскопічної адреналектомії. Усім пацієнткам застосовувався алгоритм етапного періопераційного гемодинамічного менеджменту (ЕПОГМ): передопераційна таблетована гіпотензивна терапія до надходження в стаціонар, передопераційна інфузійна керована гіпотензивна терапія урапідилом та корекція гіповолемії збалансованими кристалоїдними розчинами та 10% розчином гідроксіетилкрохмалю (ГЕК) (200/0,5) на 2-му етапі, інтраопераційна інфузійна керована гіпотензивна терапія урапідилом на 3-му етапі під контролем інвазивного та неінвазівного моніторингу гемодинаміки й профілактика надниркової недостатності та корекція гіповолемії. Результати та обговорення. У всіх хворих був вірогідно (p < 0,001) відмічений підвищений рівень метанефринів добової сечі до 1831,6 ± 337,9 мкг/24 год (контроль — 169,3 ± 12,7 мкг/24 год). Згідно з розробленим алгоритмом ЕПОГМ на першому етапі застосовували доксазозин у дозі 10,0 ± 1,0 мг або урапідил у дозі 144,0 ± 11,2 мг у 2 прийоми. На другому етапі виконували гемодилюцію 10% розчином ГЕК (200/0,5) та інфузійну керовану гіпотензивну терапію урапідилом із середньою швидкістю 9,7 ± 1,9 мг/год. На третьому етапі інтраопераційно швидкість інфузії урапідилу становила 1,25 ± 0,08 мг/хв (додатково при хірургічному виділенні надниркової залози з феохромоцитомою болюсно вводився урапідил 25–50 мг в/в при виявленні навіть мінімального підвищення артеріального тиску). На четвертому етапі здійснювалась профілактика надниркової недостатності та гіповолемії. Висновки. Упровадження анестезіологічного менеджменту пацієнтів з феохромоцитомами в спеціалізованому ендокринологічному центрі забезпечило високу ефективність та безпеку при лапароскопічних адреналектоміях під час загальної анестезії. ЕПОГМ при підготовці до операції та під час хірургічного втручання є ефективним, легко керованим та безпечним методом стабілізації показників гемодинаміки. Летальних випадків не було.

A Nomogram for Predicting Intraoperative Hemodynamic Instability in Patients With Pheochromocytoma.

PurposeSurgical removal of pheochromocytoma (PCC), including open, laparoscopic, and robot-assisted adrenalectomy, is the cornerstone of therapy, which is associated with high risk of intraoperative and postoperative life-threatening complications due to intraoperative hemodynamic instability (IHD). This study aims to develop and validate a nomogram based on clinical characteristics as well as computed tomography (CT) features for the prediction of IHD in pheochromocytoma surgery.MethodsThe data from 112 patients with pheochromocytoma were collected at a single center between January 1, 2010, and December 31, 2019. Clinical and radiological features were selected with the least absolute shrinkage and selection operator regression analysis to predict IHD then constitute a nomogram. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultsAge, tumor shape, Mayo Adhesive Probability score, laterality, necrosis, body mass index, and surgical technique were identified as risk predictors of the presence of IHD. The nomogram was then developed using these seven variables. The model showed good discrimination with a C-index of 0.773 (95% CI, 0.683–0.862) and an area under the receiver operating characteristic curve (AUC) of 0.739 (95% CI, 0.642–0.837). The calibration plot suggested good agreement between predicted and actual probabilities. Besides, calibration was tested with the Hosmer–Lemeshow test (P = 0.961). The decision curve showed the clinical effectiveness of the nomogram.ConclusionsOur nomogram based on clinical and CT parameters could facilitate the treatment strategy according to assessment of the risk of IHD in patients with pheochromocytoma.

Particular aspects in pheochromocytoma

We aim to address incomplete procedures of adrenalectomy for pheochromocytoma (PHEO) on a bases of a mini-review. Dopamine, adrenaline and noradrenaline – secretor tumors are rare in general population, representing a neuroendocrine neoplasia with a strong genetic driving force and uncertain profile concerning a malignant behavior which may be less or more predicted based on initial post-operative report. There is no linear correlation with the post-operative recurrence in terms of clinical presentation, timing and prognostic. The first laparoscopic – based PHEO removal was done in 1992; and since then, the open procedure was replaced in majority of cases by the new gold standard – laparoscopic adrenalectomy; a current conversion rate is of 5%; alpha and beta - blockade is mandatory for preoperative management since an adrenergic crisis might be triggered by higher intraabdominal pressure during laparoscopy; bilateral PHEO may be addressed through one time procedure; minimally invasive technique is done trans-peritoneal or retroperitoneal; robotic – assisted laparoscopic procedure is the next logical step from traditional laparoscopy; in children, minimally invasive procedure is less likely to be used as in adults. Partial adrenalectomy (in terms of cortical - sparing technique) should be rarely performed for unilateral PHEO; its potential utility is for cases with non-feasible total removal due to tumor anatomy (like advanced local disease) or bilateral adrenal involvement in hereditary syndromes (like MEN 2A, VHL), especially in children and young adults to overcome the need of life long glucocorticoid replacement due to chronic adrenal insufficiency. A meta-analysis focusing on recurrence after total adrenalectomy revealed a 3% ratio after 2 years in PHEO. The percent for partial procedure is more than 10% depending on study. In conclusion, a particular aspect in PHEO management is the recurrence after an adrenalectomy, typically after a partial procedure. Unless bilateral involvement or a clear diagnostic of a hereditary syndrome involving bilateral PHEO, partial adrenalectomy should be limited.

Adrenal Pheochromocytoma: A Case Report

Pheochromocytoma is a rare catecholamine secreting tumour originating usually from adrenal medulla and produces signs and symptoms due excessive catecholamine secretion from tumour. A young male patient of 36 yrs age presented with hypertension since 2 yrs, palpitation, profuse sweating, weight loss. Clinical suspicion of Pheochromocytoma was confirmed by CT scan and USG abdomen followed by catecholamines levels in plasma and urine. After preoperative preparation laparascopic removal of Pheochromocytoma was done. Postoperative recovery was uneventful and BP regains to normal range from 1st postoperative day. Pheochromocytoma is a rare cause of hypertension. If the diagnosis of Pheochromocytoma is overlooked, the consequences could be disastrous, even fatal; however, if a pheochromocytoma is identified, it is potentially curable, as being one of the cause of surgically correctable hypertension.

Resolution of Cardiomyopathy after Removal of Pheochromocytoma and Paraganglioma

Erenler, Feyza MD; Eric Tarnoff, Michael MD, FACS; Lechan, Ronald MD, PhD Author Information

SAT-202 Hypoglycemia Following Unilateral Pheochromocytoma Resection in the Immediate Post-Surgical Period

IntroductionHypoglycemia in the immediate post-resection period of unilateral pheochromocytoma is a potential complication but not very well recognized.Clinical CaseA 47 year old female with past medical history of Hypertension, coronary artery disease, Myocardial infarction, Depression, Systemic lupus erythematosus presented to the hospital initially for elective robotic assisted Left adrenalectomy. CT scan showed a big left adrenal mass with normal right adrenal gland. It was clinically diagnosed as Pheochromocytoma as outpatient by primary internist. Biochemical studies showed elevated serum metanephrines and normetanephrines, and urine normetanephrine.Post-surgery (< 24 hours) patient had episodes of fasting hypoglycemia with blood glucose levels as low as 68 mg/dl, accompanied with neuroglycopenic symptoms like tremors, sweating and palpitations.High dose ACTH stimulation test was performed. Serum cortisol levels were tested as 5.1, 11.7 and 14.4 mcg/dl within 0, 30 minutes and 60 minutes of Cosyntropin 250 mcg IV injection.The patient was started on Prednisone 5 mg daily to prevent any further episodes, which was successful, and was stopped by the patient one week after discharge, without any more hypoglycemia episodes. Further endocrinology work up could not be done as the patient did not follow up.Post-surgical pathology showed a 7x 5.5 x4 cm mass, which was confirmed as pheochromocytoma histopathologically and immunohistochemically by positive chromogranin, synaptophysin and BCl2 and negative for calretinin and S100.Discussion and ConclusionThe etiology of hypoglycemia after resection of unilateral pheochromocytoma can be explained by impaired glucagon secretion and decreased gluconeogenesis due to the suppression from higher catecholamine levels in the blood pre-operatively. The second mechanism is rebound insulin secretion from the pancreas due to sudden withdrawal of catecholamines.In our patient, the transient hypocortisolemia could be another reason. The lack of immunohistochemical evidence in post-surgical pathology report excluded cortisol- secreting tumor. Another rare situation, ACTH-secreting pheochromocytoma, has been reported but was not checked in the case.In a word, hypoglycemia is common after surgical removal of unilateral pheochromocytoma. Careful monitoring of patients’ glucose level in immediate post-resection period is essential to prevent transient hypoglycemia

Will the resection of pheochromocytoma improve preoperative diabetes mellitus?

To explore the likelihood of resolution of diabetes postoperatively. Besides, we would like to determine the risk factors associated with development and prognosis of diabetes. All patients in our hospital undergoing surgical removal of pheochromocytoma (PHEO) from 10 October 2010 to 21 July 2017 were retrospectively analyzed to determine those with preoperative diabetes. Preoperatively demographic data and information on diabetes were recorded. The median follow-up was 45.2 months. Finally, 67 (36.2%) patients were with diabetes among 185 patients undergoing surgery. Furthermore, 47 patients had complete follow-up. And 37 (78.7%) patients had improvement of diabetes after resection of PHEO. In details, 29 (61.7%) patients had complete resolution. Older patients were more likely to develop diabetes, and symptomatic patients with longer course of PHEO were also more susceptible to preoperative diabetes. Elevated body mass index (BMI) was a risk factor of persistent diabetes postoperatively after surgery. 36.2% of PHEO patients might be with preoperative diabetes mellitus. Older patients were more likely to present diabetes preoperatively. And the increasing length of PHEO course might be another risk factor on developing diabetes preoperatively. Resection of tumors improved diabetes in 78.7% of patients, with resolution in 61.7%. Patients with higher BMI might need treatment for diabetes postoperatively.

Perioperative anesthetic management of intestinal pseudo-obstruction as a complication of pheochromocytoma

BackgroundIntestinal pseudo-obstruction, which is a rare complication of pheochromocytoma, can be caused by hypersecreted catecholamines.Case presentationA 45-year-old woman was admitted for local recurrence of pheochromocytoma complicated by intestinal pseudo-obstruction. The intestinal pseudo-obstruction showed poor response to α-adrenergic receptor blocker and she was scheduled for surgical resection of pheochromocytoma. The surgery was uneventfully accomplished with general anesthesia combined with epidural anesthesia. The latter was performed with the aim of not only perioperative pain management but also of promoting intestinal peristalsis. The anticipated effect for intestinal peristalsis was not apparent in the early postoperative phase. The abdominal symptoms were gradually relieved over the course of about 1 month.ConclusionsFor intestinal pseudo-obstruction induced by pheochromocytoma, although inhibition of the sympathetic system by epidural infusion of local anesthetics may be promising, short-term usage of epidural local anesthetics infusion did not provide a quick recovery after pheochromocytoma removal surgery.

Pheochromocytoma

Objective: Pheochromocytomas are catecholamine-producing neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. There is no large-scale study in Taiwan at present. Our retrospective analysis was focused on clinical characteristics of Taiwanese patients with pheochromocytoma. Method: We retrospectively reviewed 48 patients who were pathologically proved as pheochromocytoma at the Kaohsiung Veterans General Hospital between Jan. 1990 and Jan. 2014. Parameters including patient and tumor characteristics, clinical presentation, treatment and long-term followup results were collected from the medical records. Metastasis was confirmed by pathologic proof using surgical removal or percutaneous biopsy. Result: Thirty-one patients (64.5%) had adrenal and 17 (35.4%) had extra-adrenal pheochromocytoma. The locations of extra-adrenal pheochromocytoma included the retroperitoneum in 6 patients (35%), head and neck in 4 (23%), scrotum in 2 (12%), urinary bladder in 2 patients (12%), multiple organs in 2 (12%), and mediastinum in 1 (6%). The most common symptom was sustained hypertension (52%). Five patients were diagnosed as malignant pheochromocytoma due to pathologically proved metastasis. Conclusion: Pheochromocytomas are rare neuro-endocrine tumors with a highly variable clinical presentation. Prompt surgical removal of pheochromocytoma ensures a better prognosis. Radical surgical removal of tumor with vigorous control of blood pressure is the mainstay to improve symptoms and survival for malignant pheochromocytoma. Multi-center and large-scale studies were warranted and Lifelong followup is strongly recommended for all patients with pheochromocytoma.

VE54 - Robotic assisted partial cystectomy for removal of bladder pheochromocytoma

VE54 - Robotic assisted partial cystectomy for removal of bladder pheochromocytoma

Improvement of insulin secretion and oral glucose tolerance after pheochromocytoma removal: a case report

Improvement of insulin secretion and oral glucose tolerance after pheochromocytoma removal: a case report

Two Decades of Laparoscopic Adrenalectomy: 326 Procedures in a Single-Center Experience.

Aim of this study is to evaluate the results of 20-year single-center laparoscopic adrenalectomy (LA), with different transperitoneal techniques. Three hundred twenty-six adrenalectomies were performed from 1993 to 2013 using a transperitoneal approach through anterior access, flank access, and anterior submesocolic access (adopted by the author for left LA since 2004). Overall 142 men and 184 women (mean age 59.3 y) underwent 196 right, 113 left, and 17 bilateral adrenalectomies. There was 1 fatal outcome (0.30%) due to sepsis. Conversion to open surgery was required in 7 patients (2.14%) for intraoperative bleeding (n=5), paroxysmal hypertension during pheochromocytoma removal (n=1), and tearing of the colon during bilateral adrenalectomy in a patient with Cushing hyperplasia (n=1).There were 15 postoperative complications (4.60%) managed conservatively. Transperitoneal LA is a safe, minimally invasive procedure ensuring early recovery. The submesocolic access is faster and minimizes surgical dissection.

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

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 ...

Biochemical Testing After Pheochromocytoma Removal: How Early?

Biochemical Testing After Pheochromocytoma Removal: How Early?

Biochemical Testing After Pheochromocytoma Removal: How Early?

Pheochromocytomas are catecholamine-producing tumors with typical clinical presentation. Tumor resection is considered as an appropriate treatment strategy. Due to its unpredictable clinical behavior, biochemical testing is mandatory to confirm the success of tumor removal after surgery. The aim of the study was to investigate the feasibility of a shorter interval of postoperative testing (earlier than the recommended 2-4 weeks according to recently published Guidelines). We investigated 81 patients with pheochromocytoma before and after surgery. Postoperative examination was performed of stable subjects after their transport from the surgical to the internal ward (7.1±2.2 days after surgery). Plasma metanephrines were used for the diagnosis of pheochromocytoma and confirmation of successful tumor removal. All subjects with pheochromocytoma had markedly elevated plasma metanephrines before surgery. No correlation between postoperative interval (the shortest being 3 days) and plasma metanephrine levels was found. Postoperative plasma metanephrine levels did not differ significantly from those taken at the one-year follow-up. In conclusion, we have shown that early postoperative diagnostic workup of subjects with pheochromocytoma is possible and may thus simplify early postoperative management of this clinical condition.

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

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 ...

Anesthesia for surgical removal of pheochromocytoma in a child with diabetes insipidus

Anesthesia for surgical removal of pheochromocytoma in a child with diabetes insipidus

715 Impaired glucose tolerance predicts the development of hypoglycemia after removal of pheochromocytoma

715 Impaired glucose tolerance predicts the development of hypoglycemia after removal of pheochromocytoma

Post-operative refractory hypotension and diuresis in a case of bilateral pheochromocytoma

Pheochromocytomas are relatively uncommon tumors, with prevalence of 0.3-0.95% in autopsy series. Patients with pheochromocytomas have a potentially curable cause of hypertension. Following surgical removal of pheochromocytoma 80% of patients are expected to become normotensive. Persistent post-operative hypertension may be due to residual tumor, metastatic disease or intra-operative injury to the renal artery or the kidney. Around 20% of patients will remain hypertensive without biochemical evidence of residual tumor; however, due to associated essential hypertension or due to acquired renovascular changes. We present a rare case of refractory hypotension in a post-operative case of bilateral pheochromocytoma.