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Yu Y, Chen C, Meng L, Han W, Zhang Y, Zhang Z, Yang Y. Hypertension and cardiac damage in pheochromocytoma and paraganglioma patients: a large-scale single-center cohort study. BMC Cardiovasc Disord 2024; 24:325. [PMID: 38926862 PMCID: PMC11200840 DOI: 10.1186/s12872-024-03936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Hypertension (HT) is one of the most common manifestations in patients with catecholamine-secreting neuroendocrine tumors. Although the cardiovascular manifestations of these tumors have been described, there have been no large-scale investigations of the profile of HT and changes in cardiac structure and function that occur in patients with pheochromocytomas and paragangliomas (PPGL). MATERIALS AND METHODS In this study, we investigated the prevalence of HT and left ventricular remodeling (LVR) in a cohort of 598 patients who underwent surgery for PPGL at our center between January 2001 and April 2022. Information on demographics, reason for hospitalization, medical history, biochemical parameters, findings on echocardiography, and tumor characteristics were recorded. The LVR index was compared according to whether or not there was a history of HT. RESULTS The average age was 47.07 ± 15.07 years, and 277 (46.32%) of the patients were male. A history of HT was found in 423 (70.74%) of the 598 patients. Paraganglioma was significantly more common in the group with HT (26.00% vs. 17.71%, P = 0.030) and significantly less likely to be found incidentally during a health check-up in this group (22.93% vs. 59.43%, P < 0.001). Among 365 patients with complete echocardiography data, left ventricular mass index (86.58 ± 26.70 vs. 75.80 ± 17.26, P < 0.001) and relative wall thickness (0.43 ± 0. 08 vs. 0.41 ± 0.06, P = 0.012) were significantly higher in patients with PPGL and a history of HT. The proportions with left ventricular hypertrophy (LVH) (19.40% vs. 8.25%, P = 0.011) and LVR (53.73% vs. 39.18%, P = 0.014) were also higher when there was a history of HT. After adjusting for age, gender, body mass index, alcohol consumption, smoking status, diabetes, stroke, creatinine level, tumor location, and tumor size, a history of HT was significantly correlated with LVH (odds ratio 2.71, 95% confidence interval 1.18-6.19; P = 0.018) and LVR (odds ratio 1.83, 95% confidence interval 1.11-3.03; P = 0.018). CONCLUSION HT is common in patients with PPGL (70.74% in this cohort). PPGL without a history of HT is more likely to be found incidentally (59.43% in our cohort). HT is associated with LVR in PPGL patients with complete echocardiography data. These patients should be observed carefully for cardiac damage, especially those with a history of HT.
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Affiliation(s)
- Yang Yu
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Chuyun Chen
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Lei Meng
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Wencong Han
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.
- Institute of Urology, Peking University, Beijing, China.
- National Urological Cancer Center, Peking University First Hospital, Beijing, China.
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, Beijing, China.
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China.
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Petrák O, Krátká Z, Holaj R, Zítek M, Nguyen Nikrýnová T, Klímová J, Kološová B, Waldauf P, Michalský D, Novák K, Markvartová A, Zlatohlávek L, Grus T, Dušková J, Widimský J, Zelinka T. Cardiovascular Complications in Pheochromocytoma and Paraganglioma: Does Phenotype Matter? Hypertension 2024; 81:595-603. [PMID: 38152977 DOI: 10.1161/hypertensionaha.123.21902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Adrenaline-producing tumors are mostly characterized by a sudden release of catecholamines with episodic symptoms. Noradrenergic ones are usually less symptomatic and characterized by a continuous overproduction of catecholamines that are released into the bloodstream. Their effects on the cardiovascular system can thus be different. The aim of this study was to determine the prevalence of cardiovascular complications by catecholamine phenotype. METHODS We retrospectively analyzed data on the prevalence of cardiovascular events in 341 consecutive patients with pheochromocytoma and paraganglioma treated from 1995 to 2023. Biochemical catecholamine phenotype was determined based on plasma or urinary catecholamines and metanephrines. RESULTS According to the phenotype, 153 patients had noradrenergic pheochromocytoma and paraganglioma and 188 had adrenergic pheochromocytoma and paraganglioma. In the whole sample, the incidence of serious cardiovascular complications was 28% (95 patients), with no difference between the phenotypes or sexes. The noradrenergic phenotype had significantly more atherosclerotic complications (composite end point of type 1 myocardial infarction and symptomatic peripheral artery disease; odds ratio, 3.58 [95% CI, 1.59-8.83]; P=0.003), while the adrenergic phenotype more often had type 2 myocardial infarction and takotsubo-like cardiomyopathy (OR, 0.24 [95% CI, 0.09-0.57]; P=0.002). These changes remained even after adjustment for conventional risk factors of atherosclerosis. CONCLUSIONS We found a 28% incidence of cardiovascular complications in a consecutive group of patients with pheochromocytoma and paraganglioma. Patients presenting with a noradrenergic phenotype have a higher incidence of atherosclerotic complications, while the adrenergic phenotype is associated with a higher incidence of acute myocardial damage due to takotsubo-like cardiomyopathy.
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Affiliation(s)
- Ondřej Petrák
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Zuzana Krátká
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Robert Holaj
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Matěj Zítek
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Thi Nguyen Nikrýnová
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Judita Klímová
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Barbora Kološová
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Czech Republic (P.W.)
| | - David Michalský
- Department of Urology, 1st Faculty of Medicine (D.M.), Charles University and General University Hospital in Prague, Czech Republic
| | - Květoslav Novák
- 1st Surgical Clinic, Thoracic, Abdominal and Injury Surgery, 1st Faculty of Medicine (K.N.), Charles University and General University Hospital in Prague, Czech Republic
| | - Alice Markvartová
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Lukáš Zlatohlávek
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Tomáš Grus
- 2nd Surgical Clinic, Cardiovascular Surgery, 1st Faculty of Medicine (T.G.), Charles University and General University Hospital in Prague, Czech Republic
| | - Jaroslava Dušková
- Institute of Pathology, 1st Faculty of Medicine (J.D.), Charles University and General University Hospital in Prague, Czech Republic
| | - Jiří Widimský
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
| | - Tomáš Zelinka
- 3rd Department of Internal Medicine, Endocrinology and Metabolism, 1st Faculty of Medicine (O.P., Z.K., R.H., M.Z., T.M.P.N.N., J.K., B.K., A.M., L.Z., J.W., T.Z.), Charles University and General University Hospital in Prague, Czech Republic
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Araujo-Castro M, Mínguez Ojeda C, García Centeno R, López-García MC, Lamas C, Hanzu FA, Mora M, Del Castillo Tous M, Rodríguez de Vera Gómez P, Parra Ramírez P, Alvarez-Escola C, Blanco Carrera C, Barahona San Millán R, Recasens M, Valdés N, Gracia Gimeno P, de Miguel Novoa P, Vicente A, Manjón L, García Sanz I, Michalopoulou T, Calatayud M. Glycemic disorders in patients with pheochromocytomas and sympathetic paragangliomas. Endocr Relat Cancer 2022; 29:645-655. [PMID: 36069783 DOI: 10.1530/erc-22-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/08/2022]
Abstract
The objective of our study was to determine the prevalence of glycemic disorders (diabetes mellitus and prediabetes) in patients with pheochromocytomas and sympathetic paragangliomas (PPGLs) and identify risk factors for their development and the likelihood of their resolution after surgery. A multicentric retrospective study of patients with PPGLs submitted to surgery between 2000 and 2021 in 17 Spanish hospitals was performed. Diabetes-specific data were collected at diagnosis, in the immediate- and long-term postsurgical follow-up. A total of 229 patients with PPGLs were included (218 with pheochromocytomas and 11 with sympathetic paragangliomas). Before surgery, glycemic disorders were diagnosed in 35.4% of the patients (n = 81): 54 with diabetes and 27 with prediabetes. The variables independently associated with a higher risk of glycemic disorders were sporadic PPGL (odds ratio (OR) = 3.26 (1.14-9.36)) and hypertension (OR = 3.14 (1.09-9.01)). A significant decrease in fasting plasma glucose and HbA1c levels was observed after surgery, in the short-term and long-term follow-up (P < 0.001). After a median follow-up of 48.5 months (range 3.3-168.9), after surgery, 52% of diabetic and 68% of prediabetic patients experienced a complete resolution. Lower body mass index (BMI) (P = 0.001), lower glucose levels (P = 0.047) and shorter duration of diabetes prior to surgery (P = 0.021) were associated with a higher probability of diabetes resolution. In conclusion, glycemic disorders in patients with PPGLs are present in more than a third of them at diagnosis. Sporadic PPGLs and hypertension are risk factors for their development. More than 50% of cases experience a complete resolution of the glycemic disorder after resection of the PPGLs.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | | | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, Albacete, Spain
| | | | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - María Del Castillo Tous
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | | | | | - Mónica Recasens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Paz de Miguel Novoa
- Endocrinology & Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Almudena Vicente
- Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain
| | - Laura Manjón
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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Januszewicz A, Mulatero P, Dobrowolski P, Monticone S, Van der Niepen P, Sarafidis P, Reincke M, Rexhaj E, Eisenhofer G, Januszewicz M, Kasiakogias A, Kreutz R, Lenders JW, Muiesan ML, Persu A, Agabiti-Rosei E, Soria R, Śpiewak M, Prejbisz A, Messerli FH. Cardiac Phenotypes in Secondary Hypertension. J Am Coll Cardiol 2022; 80:1480-1497. [DOI: 10.1016/j.jacc.2022.08.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
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Yu Y, Chen C, Han W, Zhang Y, Zhang Z, Yang Y. Metanephrine and normetanephrine associated with subclinical myocardial injuries in pheochromocytoma and paraganglioma. Front Oncol 2022; 12:1024342. [PMID: 36237312 PMCID: PMC9552905 DOI: 10.3389/fonc.2022.1024342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the correlation between metanephrine and normetanephrines (MNs) and subclinical myocardial injuries (SMI) diagnosed by low left ventricular global longitudinal strain (LV GLS) in patients with pheochromocytoma and paraganglioma (PPGL). Methods Seventy-six patients who underwent surgery for pheochromocytoma or paraganglioma from September 2017 to April 2022 were examined. All the patients enrolled had normal left ventricular ejection fraction (LVEF) and myocardial injury biomarkers including cardiac troponin I and B-natriuretic peptide. Univariate analysis and multivariate analysis were performed to evaluate the association of MNs and subclinical myocardial injury (SMI)(defined as LV GLS<18). Results LV GLS of 13(17.11%) PPGL patients was less than 18. The percentage of patients with elevation of single hormone (metanephrine, normetanephrine, 3-methoxytyramine) or any one of MNs was not significantly correlated with SMI (P=0.987, 0.666, 0.128 and 0.918, respectively). All MNs elevation was associated with SMI (OR: 11.27; 95% CI, 0.94—135.24; P= 0.056). After adjusting for age, All MNs elevation was significantly correlated with SMI (OR: 16.54; 95% CI, 1.22—223.62; P= 0.035). Conclusion MNs might be an important factor influencing myocardial function. All MNs elevation might indicate SMI. If all MNs elevated, LV GLS measurement was recommended for PPGL patients to detect SMI in the absence of decrease LVEF or other heart disease in clinical practice.
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Affiliation(s)
- Yang Yu
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Chuyun Chen
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Wencong Han
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Peking University First Hospital, Beijing, China
- *Correspondence: Zheng Zhang, ; Ying Yang,
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- *Correspondence: Zheng Zhang, ; Ying Yang,
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Zhao L, Meng X, Mei Q, Fan H, Liu Y, Zhou X, Zhu H, Zhang S. Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study. Front Endocrinol (Lausanne) 2022; 13:877341. [PMID: 35721724 PMCID: PMC9199364 DOI: 10.3389/fendo.2022.877341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Catecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations. Although there are reviews of reported cases, these reviews lack detailed data, which makes it impossible to perform an accurate analysis. In this study, we conducted a comprehensive analysis of cardiovascular complications (CCs), including PPGL-related myocardial injury, cardiogenic shock, and arrhythmias requiring antiarrhythmic therapy, in a large cohort of patients with PPGL. METHODS We retrospectively analyzed the clinical data of consecutive patients with PPGL admitted between January 2018 and June 2020. The prevalence and the characteristics of patients with CCs were investigated. Moreover, comparisons were made between patients with and without CCs. RESULTS Compared with the non-CC group, the percentage of men was significantly lower (14/41 vs.92/175, 34.1% vs. 52.6%, p = 0.034) and the proportion of patients with paroxysmal hypertension was significantly higher (13/41 vs.29/173, 31.7% vs.16.8%, p = 0.03) in the CC group. More patients showed excessive sweating (19/41 vs 64/175, 46.3% vs. 24.0%, p = 0.004) and PPGL crisis (7/41 vs. 10/175, 17.1% vs.5.7%, p=0.035) in the CC group. In terms of laboratory findings, higher white blood cell [7.36 (6.49, 20.23) vs. 5.95 (5.1, 6.97)×109/L, p<0.001] and platelet [339.28 ± 108.54 vs. 250.66 ± 70.83(×109/L), p = 0.021] counts were more common in the CC group. There was also a higher prevalence of combination-producing PPGL in the CC group (13/24 vs.20/149, 54.2% vs.13.4%, p<0.001). However, the tumor size, invasive behavior on histology, and hemorrhage or necrosis on histology did not differ between the two groups. Platelet count [odds ratio (OR): 1.009; 95% confidence interval (CI) 1.001-1.016; p=0.023] and combination-secreting PPGL (OR: 5.009; 95% CI 1.365-18.38; p=0.015) are independent risk factors for CCs in patients with PPGL. CONCLUSIONS In patients with PPGL, even in the absence of signs and symptoms of CCs, a work up of cardiology should be strongly considered. Importantly, if patients with PPGLs have higher platelet counts and the combination-secreting pattern, they are more likely to have CCs. Thus, a careful cardiac evaluation should be performed.
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Affiliation(s)
- Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - QiMin Mei
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hua Fan
- Department of Urology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - YeCheng Liu
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: YeCheng Liu, ; XianLiang Zhou, ; HuaDong Zhu, ; ShuYang Zhang,
| | - XianLiang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: YeCheng Liu, ; XianLiang Zhou, ; HuaDong Zhu, ; ShuYang Zhang,
| | - HuaDong Zhu
- Department of Emergency, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: YeCheng Liu, ; XianLiang Zhou, ; HuaDong Zhu, ; ShuYang Zhang,
| | - ShuYang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: YeCheng Liu, ; XianLiang Zhou, ; HuaDong Zhu, ; ShuYang Zhang,
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Araujo-Castro M, García Centero R, López-García MC, Álvarez Escolá C, Calatayud Gutiérrez M, Blanco Carrera C, De Miguel Novoa P, Valdés Gallego N, Hanzu FA, Gracia Gimeno P, Fernández-Ladreda MT, Percovich Hualpa JC, Mora Porta M, Lorca Álvaro J, Pian H, Caracuel IR, Sanjuanbenito Dehesa A, Gómez Dos Santos V, Serrano Romero A, Oliveira CL. Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY. Endocrine 2021; 74:676-684. [PMID: 34373995 DOI: 10.1007/s12020-021-02843-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery. METHODS A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale. RESULTS One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P = 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82, P < 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n = 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. CONCLUSION Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Unit. Department of Endocrinology & Nutrition. Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Department of Health Science, Universidad de Alcalá, Madrid, Spain.
| | | | | | | | | | | | - Paz De Miguel Novoa
- Department of Endocrinology & Nutrition, Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Valdés Gallego
- Department of Endocrinology & Nutrition, Hospital de Universitario de Cabueñes, Asturias, Spain
| | - Felicia A Hanzu
- Department of Endocrinology & Nutrition & Group of Endocrine Disorders. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Royo Villanova, Zaragoza, Spain
| | | | | | - Mireia Mora Porta
- Department of Endocrinology & Nutrition & Group of Endocrine Disorders. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Javier Lorca Álvaro
- Department of Urology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Héctor Pian
- Department of Pathology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Ruz Caracuel
- Department of Pathology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Ana Serrano Romero
- Department of Anesthesia, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Lamas Oliveira
- Department of Endocrinology & Nutrition, Hospital Universitario de Albacete, Albacete, Spain
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Tadic M, Sala C, Carugo S, Cuspidi C. Effect of surgical treatment on myocardial strain in patients with pheochromocytoma and paraganglioma: a mini-review and meta-analysis. J Endocrinol Invest 2021; 44:2327-2332. [PMID: 34235707 DOI: 10.1007/s40618-021-01631-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
AIM Information on systolic dysfunction, as assessed by left-ventricular (LV) mechanics, in patients with pheochromocytoma after surgical treatment is scanty. We performed a systematic meta-analysis of speckle tracking echocardiographic studies to provide an updated comprehensive information on this issue. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to May 31st 2021. Studies were identified using MeSH terms and crossing the following search items: "myocardial strain" "left ventricular mechanics", "speckle tracking echocardiography", "systolic dysfunction", "pheochromocytoma", and "paraganglioma". RESULTS A total of 92 surgically treated patients with pheochromocytoma/paraganglioma were included in 3 longitudinal studies. Successful surgical treatment was associated with a decrease in relative wall thickness (SMD - 0.25 ± 0.10, CI - 0.45/- 0.05, p < 0.01) and an improvement in global longitudinal strain (SMD - 0.45 ± 0.10, CI - 0.66/- 0.24, p < 0.0001). The favorable effects of treatment on LV geometry and mechanics were not accompanied by significant changes in ejection fraction (SMD - 0.07 ± 0.10, CI - 0.27/0.12, p = 0.44). CONCLUSIONS This meta-analysis adds a new piece of evidence, suggesting that surgical treatment of patients with pheochromocytoma impacts favorably on LV geometry and LV mechanics, and, more importantly, the assessment of LV changes in this setting can no longer rely on conventional echocardiographic parameters such as ejection fraction.
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Affiliation(s)
- M Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic-Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - C Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico Di Milano, Milan, Italy
| | - S Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico Di Milano, Milan, Italy
| | - C Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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