Background: Pheochromocytoma is a rare adrenal gland tumor. The definitive treatment is an adrenalectomy. Because of its secretory nature, appropriate preoperative treatment is essential to prevent hypertensive crisis (HTC) during surgery. Despite this management, HTC is common and can cause life-threatening complications. We aimed to study variables that may affect HTC despite preoperative management. Methods:In a retrospective study, among 126 medical records of patients with adrenal tumors who were referred to Alzahra Hospital, Isfahan, Iran, between 2013 and 2021, 52 patients who took proper preparation for surgery were included.Results: Analysis of these patients (aged 15 -72 years, 30 females) showed that 12 patients (23.1%) experienced HTC. The mean age in the HTC group was 44.0 ± 15.3 and in the non-HTC group was 45.6 ± 13.2 (P = 0.724). Among many potential predictors, we observed in a multivariate analysis that patients with tumors size > 33.5 mm were at higher risk for experiencing HTC (P = 0.038, odds ratio (OR): 13.1, confidence interval (CI): 1.26 -135.26); taking amlodipine to help reduce blood pressures (BPs) was another significant predictor (P = 0.05, OR: 5.1, CI: 0.97 -56.74). Mean values of systolic BP (SBP) and diastolic BP (DBP) before surgery in the HTC group were more, although it was not statistically significant. Patients' past medical history, 24-h urine metanephrine, normetanephrine, epinephrine, norepinephrine, vanillymandelic acid (VMA), and surgical technique were not significantly distributed between HTC and non-HTC patients (P > 0.05). Conclusion:Tumor sizes > 33.5 mm and the necessity of administering amlodipine to control BP were predictors of HTC. Due to the rarity of pheochromocytoma, multicenter studies with larger sample sizes for providing more reliable results are suggested.

BackgroundPheochromocytoma is a rare adrenal gland tumor.The definitive treatment is adrenalectomy. Because of its secretory nature, appropriate preoperative treatment is essential to prevent hypertensive crisis(HTC) during surgery.Despite this management,HTC is common and can cause life-threatening complications.AimOur aim was to study variables that may affect HTC despite preoperative management.MethodsIn a retrospective study,among 126 medical records of patients with adrenal tumor who referred to Alzahra hospital, Isfahan,Iran,between 2013 and 2021,52 patients who took proper preparation for surgery were included.ResultsAnalysis of these patients showed that 12 patients experienced HTC. Among many potential predictors, we observed in multivariate analysis that patients with tumors size > 33.5mm in imaging were at higher risk for experiencing HTC (P = 0.038,OR:13.1,CI:1.26–135.26); taking amlodipine to help reducing blood pressures(BPs) was another significant predictor (P = 0.05,OR:5.1,CI:0.97–56.74). Mean values of systolic BP(SBP) and diastolic BP(DBP) before surgery in HTC group was more, although it wasn’t statistically significant.ConclusionTumor sizes > 33.5mm(imaging)and necessity of administering amlodipine to control BP were predictors of HTC but when reported by pathology,it wasn’t significantly different and it suggests that tumor size has no effect on HTC.However, due to rarity of pheochromocytoma, multicenter studies with larger sample size for providing more reliable results are suggested.

Background Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis. Its severity ranges from indolent disease to fulminant that may cause death. With treatment, remission is seen in more than 80% of cases, although relapse is still common. There have been studies showing that there may be factors to predict relapse in GPA. Based on relapses, the decision to start treatment and/or to monitor the patients more closely is made. Therefore, predicting the relapse of GPA can be effective in controlling the disease. Our aim was to investigate possible factors for relapse in GPA. We recruited 254 patients diagnosed with GPA who were under treatment at Alzahra hospital affiliated to Isfahan University of Medical Sciences (from 2013 to 2020) and Amir Alam Hospital affiliated to Tehran University of Medical Sciences (from 2020 to 2022) to plan a retrospective study. Chi-squared or Fisher’s exact tests were performed to compare categorical variables, while the Mann–Whitney U test was used to compare continuous variables. Results Analysis of our patients (aged 20–80,122 females) showed that 147 patients (57.9%) experienced relapse. Mean age in relapse group was 43.8 ± 16.6 and in no-relapse group was 45.6 ± 15.1 (P > 0.05). Among many potential predictors, we observed in multivariate analysis that positive PR3-ANCA (proteinase 3-antineutrophilic cytoplasmic antibodies) (P = 0.007, OR:2.62,CI:1.29–5.31),nose manifestations (P = 0.004, OR 3.00, CI 1.43–6.26), mucosal membranes involvement (P = 0.009, OR 4.21, CI 1.43–12.38), and gastrointestinal tract (GI) complications (P = 0.03, OR 5.64, CI 1.14–27.90) were significant predictors of GPA relapse. Conclusion Among clinical and laboratory features we studied, positive PR3-ANCA, nose manifestations, mucosal membranes involvement, and GI complications were independent predictors of relapse in patients with GPA.