Influence of secretory phenotype and preoperative preparation on surgical outcome in pheochromocytoma

in Endocrine Connections
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  • 1 R Furnica, Endocrinology , Cliniques universitaires Saint-Luc, Bruxelles, 1200, Belgium
  • 2 M Dusoruth, Endocrinology , Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  • 3 A Persu, Cardiology , Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  • 4 D Gruson, Laboratory Medicine, Cliniques universitaires Saint-Luc, Bruxelles, 1200, Belgium
  • 5 M Mourad, Endocrine Surgery , Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  • 6 D Maiter, Endocrinology , Cliniques universitaires Saint-Luc, Bruxelles, Belgium

Correspondence: Dominique Maiter, Email: dominique.maiter@uclouvain.be

Objectives: Surgery of pheochromocytomas (PCs) still carries a high risk of hemodynamic complications during the perioperative period. We aimed to evaluate the influence of their secretory phenotype and preoperative alpha-blocker treatment on surgical outcome.

Design: a retrospective monocentric study at a tertiary medical centre.

Patients: 80 consecutive patients operated by the same team for a PC between 1988 and 2018.

Results: Diagnosis was based on typical symptoms and signs in 58 patients, genetic testing in 12 and work-up of an adrenal incidentaloma in 9. It was made during surgery in one patient. A genetic predisposition was found in one third of index cases (21/62). The majority of the patients (73/79) had a secreting PC; more than 2/3 had an adrenergic phenotype and less than 1/3 a noradrenergic phenotype. The rate of perioperative hemodynamic complications was not influenced by the secretory phenotype, but persistent hypertension after surgery, recurrence and malignancy were more frequently observed in patients with a noradrenergic tumour. Preoperative alpha-blocker treatment was given for ≥ 14 days in 29 patients and, although being more symptomatic at diagnosis, these patients had less hemodynamic complications (3/29 vs. 12/51 non-treated patients, p=0.05).

Conclusions: The occurrence of hemodynamic complications during surgery was not significantly affected by the secretory phenotype in our study, but noradrenergic tumours show a worse post-surgical outcome. Our data also provide additional support in favor of a sufficient preoperative alpha-blockade in patients with pheochromocytoma.

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     European Society of Endocrinology

     Society for Endocrinology

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