Front Endocrinol (Lausanne). 2022;13:816833.

Characteristics of Intraoperative Hemodynamic Instability in Postoperatively Diagnosed Pheochromocytoma and Sympathetic Paraganglioma Patients.

, , , ,

제1저자 김정희 · 교신저자 김수진

PMID 35282440 PMC8907447 DOI 10.3389/fendo.2022.816833 IF 5.7 내분비대사내과

소속 (7)

Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, South Korea.
Medical Big Data Research Center, Institute of Medical and Biological Engineering, Seoul National University, Seoul, South Korea.
Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

BACKGROUND Despite an improved understanding of pheochromocytoma and extra-adrenal sympathetic parganglioma (PPGL), including diagnosis and management, some PPGLs are postoperatively diagnosed. Clinical characteristics and intraoperative haemodynamic instability (HI) in postoperatively diagnosed PPGL patients have been poorly defined. Thus, we investigated the clinical characteristics and HI in patients with postoperatively diagnosed PPGLs compared to patients with preoperatively diagnosed PPGLs.

METHODS We obtained clinical and haemodynamic data from the electronic medical records of 256 patients with pathologically confirmed PPGLs at our institution from January 2005 to December 2019. We assessed the intraoperative HI (systolic blood pressure [SBP]>160 mmHg (min) or mean blood pressure [MBP]<60 mmHg (min)) over time.

RESULTS Twenty-nine patients (11.3%) were diagnosed with PPGLs postoperatively. Hypertension (34.5% vs. 63.0%, P=0.006) and pheochromocytoma (17.2% vs. 81.1%, P<0.001) case rates were lower in postoperatively diagnosed patients than in preoperatively diagnosed patients. Preoperative SBP in the ward was similar between groups, but the use of α-blockers and β-blockers was more frequent in preoperatively diagnosed patients (89.0% vs. 3.4%, P<0.001; 36.3% vs. 6.9%, P=0.003). Considering intraoperative HI, postoperatively diagnosed patients demonstrated a similar percentage of time with SBP>160 mmHg (median [IQR]; 7.9% [2.5; 11.9] % vs. 4.6% [0.0; 11.9], P=0.088) but a significantly lower percentage of time with MBP<60 mmHg (0.0% [0.0; 3.0] vs. 5.6% [0.0, 12.6], P=0.002) compared with preoperatively diagnosed patients.

CONCLUSIONS Patients diagnosed with PPGLs postoperatively may have no further higher risk of intraoperative hypertension than those diagnosed preoperatively despite insufficient preoperative management for PPGLs. Further study will be needed to ascertain intrinsic tumour characteristics, and need for universal preoperative use of α- and β-blockers in PPGL patients postoperatively diagnosed or without typical symptoms related PPGLs.

Keywords

haemodynamic instabilityintraoperative hypertensionintraoperative hypotensionparagangliomapheochromocytoma

Figures

**Figure 1** Percentage of time with BP outside the target ranges (SBP > 160 mmHg, or MBP < 60 mmHg) over surgical duration according to the time of diagnosis. Postoperatively diagnosed patients demonstrated a similar percentage of time with an SBP > 160 mmHg (median [IQR]; 7.9% [2.5; 11.9] % *vs.* 4.6% [0.0; 11.9], P = 0.088) but a significantly lower percentage of time with an MBP <60 mmHg (0.0% [0.0; 3.0] *vs.* 5.6% [0.0, 12.6], P = 0.002) compared with preoperatively diagnosed patients.

그림 출처: PubMed Central 공개 논문 (PMC8907447)

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

그 밖의 정보