Hypoglycemia after resection of pheochromocytoma

Chen, Yufei; Hodin, Richard A.; Pandolfi, C; Ruan, Daniel T.; McKenzie, Travis J.

doi:10.1016/j.surg.2014.08.020

Cited by 51 publications

(46 citation statements)

References 22 publications

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“…The present study showed that the preoperative urinary epinephrine level, but not the urinary norepinephrine level, is a predictor for post‐excisional hypoglycemia. Consistently, previous studies showed that epinephrine‐predominant tumors can predict hypoglycemia . As sudden withdrawal of beta‐adrenergic stimulation and alpha‐stimulation together contributes to post‐excisional hypoglycemia development, the preoperative level of epinephrine, which has both alpha‐ and beta‐agonist capacities, could be more predictive of post‐excisional hypoglycemia than norepinephrine, which has only alpha‐agonist capacity.…”

Section: Discussionsupporting

confidence: 78%

“…Although most patients recover quickly with intravenous glucose therapy, careful monitoring is mandatory, because hypoglycemia could be prolonged or recurrent and cause severe neurological complications . A study of the perioperative complications of pheochromocytoma resection reported that 15% of the patients developed post‐excisional hypoglycemia and required intensive glucose therapy; other studies reported a similar incidence of post‐excisional hypoglycemia (13.3% with hypoglycemia defined as serum glucose levels <50 mg/dL and 4.2% with hypoglycemia defined as serum glucose levels <55 mg/dL) as the present study, suggesting that post‐excisional hypoglycemia is a common complication after surgery for pheochromocytoma. These consistent results highlight the importance of careful monitoring of serum glucose levels during and after pheochromocytoma resection.…”

Section: Discussionsupporting

confidence: 76%

“…A proposed mechanism of post‐excisional hypoglycemia is excessive rebound secretion of insulin as a result of pheochromocytoma resection, which can be monitored by the ratio of serum IRI to serum glucose levels . Although hypoglycemia can cause severe neurological complications if not detected promptly, only a few small retrospective studies have addressed its occurrence in patients with pheochromocytoma …”

Section: Introductionmentioning

confidence: 99%

“…2 Although hypoglycemia can cause severe neurological complications if not detected promptly, only a few small retrospective studies have addressed its occurrence in patients with pheochromocytoma. 3,4 The present study aimed to determine the incidence of post-excisional hypoglycemia in patients who underwent pheochromocytoma resection in order to evaluate its preoperative predictive factors and analyze the association between the perioperative IRI/glucose ratio and post-excisional hypoglycemia development.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

et al. 2018

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Objectives To determine the incidence and preoperative risk factors of post‐excisional hypoglycemia in patients undergoing pheochromocytoma resection. Methods Patients who underwent surgical resection of pheochromocytoma at a single institution were retrospectively enrolled in the present study. The primary end‐point was the development of post‐excisional hypoglycemia; that is, a serum glucose level <70 mg/dL. The serum levels of immunoreactive insulin and glucose levels during the preoperative oral glucose‐tolerance test and surgery were analyzed to elucidate the mechanism of hypoglycemia. Results A total of 49 patients underwent surgical resection of pheochromocytoma, of which 21 patients (43%) developed post‐excisional hypoglycemia. The incidence of hypoglycemia was not statistically different between patients with adrenal tumors and those with extra‐adrenal tumors (18/41 [44%] vs 3/8 [38%], respectively, P = 0.73). There was no difference in the immunoreactive insulin/glucose ratio during the preoperative oral glucose‐tolerance test between patients with and those without post‐excisional hypoglycemia. The intraoperative immunoreactive insulin/glucose ratio was significantly higher in patients with hypoglycemia than in those without hypoglycemia. A higher 24‐h urinary epinephrine level, but not norepinephrine level, was a predictive factor for post‐excisional hypoglycemia. Conclusions Post‐excisional hypoglycemia is a frequent complication of pheochromocytoma resection, irrespective of the tumor location, and might be common in patients with epinephrine‐predominant tumors. All patients undergoing resection of adrenal and extra‐adrenal pheochromocytoma require intensive monitoring of serum glucose levels during and after surgery.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

et al. 2018

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“…Chen et al (2014) examined the incidence of this complication and aimed to identify predisposing risk factors. Th eir data demonstrate that hypoglycemia is a rare complication aft er resection of PHEOs and may be more common in patients with epinephrine-predominant neoplasms and longer operative times (Chen et al 2014). …”

Section: Preparation For Surgerymentioning

confidence: 99%

Pheochromocytoma, diagnosis and treatment: Review of the literature

Farrugia

Martikos

Tzanetis

et al. 2017

Endocrine Regulations

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Objective. We conducted an extensive review of the literature and tried to cite the most recent recommendations concerning the pheochromocytoma (PHEO).Methods. Pub Med and Google Scholar databases were searched systematically for studies concerning pheochromocytomas (intra-adrenal paragangliomas) from 1980 until 2016. Bibliographies were searched to fi nd additional articles.Results. More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to diagnosing pheochromocytoma. If the results are equivocal then we perform the clonidine test. If we have not done it already, we preferably do a CT scan and/or an MRI scan. Th e patient needs pre-treatment with α1-blockers at least 10-14 days before operation. Alternatives or sometimes adjuncts are Calcium Channels Blockers and/ or β-Blockers. Several familial syndromes are associated with PHEO and genetic testing should be considered.Conclusions. Th e biggest problem for pheochromocytoma is to suspect it in the fi rst place. Elevated metanephrines establish the diagnosis. With the proper preoperative preparation the risks during operation and the postoperative period are minimal. If there is a risk of the hereditable mutation, it is strongly suggested that all the patients with pheochromocytoma need clinical genetic testing.

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The frequency of postoperative hypoglycemia after pheochromocytoma surgery is decreasing

Yamanashi,

Yoshida,

Nakai

et al. 2024

World j. surg.

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BackgroundHypoglycemia after pheochromocytoma resection is one of the most common postoperative complications, with a reported incidence of 12%–43%. In recent years, we have rarely experienced postoperative hypoglycemia after pheochromocytoma surgery at our institution. We reviewed our own experience and examined factors associated with postoperative hypoglycemia in pheochromocytoma patients.MethodsWe collected and retrospectively reviewed medical information from 53 patients with pheochromocytoma who underwent initial surgery in our department between 1996 and 2022, who did not receive steroids in the perioperative period and received the same alpha‐blocker preoperatively. Subjects were divided into two groups by the midpoint of the study period: Group 1 (G1), 1996–2009; and Group 2 (G2), 2010–2022. The two groups were compared.ResultsHypoglycemia occurred significantly less often in G2 (0 patients, 0%) than in G1 (7 patients, 28%; p = 0.003). Preoperative diabetes was significantly less frequent in G2 (2 patient, 7.1%) than in G1 (8 patients, 32%; p = 0.03). Preoperative alpha‐blocker dosage was significantly higher in G2 than in G1 (p = 0.04). Multivariate logistic regression analysis showed that only alpha‐blockers dosage was significantly associated with the occurrence of postoperative hypoglycemia (p = 0.004).ConclusionThe current study suggest that the alpha‐blocker dosage might be related to the lower incidence of postoperative hypoglycemia in Pheochromocytoma patients.

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Hypoglycemia after resection of pheochromocytoma

Cited by 51 publications

References 22 publications

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

Pheochromocytoma, diagnosis and treatment: Review of the literature

The frequency of postoperative hypoglycemia after pheochromocytoma surgery is decreasing

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