Hypolgcaemic encephalopathy following surgery on phaeochromocytoma

Channa, A. B.; Mofti, Adnan B.; Taylor, G. W.; Mekki, M.; Sheikh, Maheen

doi:10.1111/j.1365-2044.1987.tb05278.x

Cited by 8 publications

(4 citation statements)

References 13 publications

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“…Six patients in our series developed severe hypoglycemia 2M 1 hours (3 hours on average) after removal of the pheochromocytoma, this result being in accordance with the interval reported in the literature (i.e., 0-4 hours) with 1~ hours on average after the end of the surgery [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The plasma IRI level was at a maximum at about 1 hour; and the plasma glucose level was at the nadir about 3 hours after the tumor excision.…”

Section: Discussionsupporting

confidence: 86%

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Hypoglycemia induced by excessive rebound secretion of insulin after removal of pheochromocytoma

Akiba¹,

Kodama²,

Ito³

et al. 1990

World j. surg.

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During an 8-year-period from 1981, a total of 6 of 45 patients with pheochromocytoma developed severe hypoglycemia (plasma glucose, 12-50 mg/dl) 2-4 1/2 hours after removal of the tumor. In order to elucidate the pathogenesis of the hypoglycemic attack, the levels of plasma immunoreactive insulin (IRI) and glucose were sequentially measured at surgery in 10 patients with pheochromocytoma, from the beginning of the operation until usually 5 hours after tumor resection. The same examinations were carried out in 4 patients with primary aldosteronism and 1 patient with Cushing's syndrome as controls. The highest plasma IRI levels observed in the 2 patients with postexcisional hypoglycemia were 174 and 2,081 microU/ml and those in the 8 patients without hypoglycemia were 13-222 microU/ml (mean, 77), but they were only 14-33 microU/ml (mean, 22) in the 5 control patients. The mean of the highest plasma IRI/glucose ratios in the immediate postoperative phase was 1.37 +/- 0.87 in the 10 patients with pheochromocytoma but only 0.16 +/- 0.04 in the 5 control patients (p less than 0.01). Review of the clinical data in our series disclosed that patients with higher levels of preoperative urinary epinephrine excretion and those with either diabetes mellitus or impaired glucose tolerance tended to develop postoperative hypoglycemia. These observations suggest that endogenous insulin secretion is suppressed by increase plasma catecholamines, and that excessive rebound secretion of insulin after removal of a pheochromocytoma is a rather common phenomenon. Intravenous infusion of glucose is necessary and plasma glucose levels should be monitored after resection of a pheochromocytoma.

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Section: Discussionsupporting

confidence: 86%

“…Hyperglycemia is also a common preoperative disorder associated with pheochromocytomas. It is surprising, however, that there have been only 16 reported cases of severe hypoglycemia following removal of a pheochromocytoma [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”

mentioning

confidence: 99%

Hypoglycemia induced by excessive rebound secretion of insulin after removal of pheochromocytoma

Akiba¹,

Kodama²,

Ito³

et al. 1990

World j. surg.

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“…If unrecognized, hypoglycemia can have severe neurologic consequences. 4 In this study, we aim to further describe the incidence and characteristics of postoperative hypoglycemia after pheochromocytoma resection and to identify risk factors for the development of this complication.…”

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confidence: 99%

Hypoglycemia after resection of pheochromocytoma

Chen

Hodin

Pandolfi

et al. 2014

Surgery

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“…Although most patients recover quickly with intravenous glucose therapy, careful monitoring is mandatory, because hypoglycemia could be prolonged 6 or recurrent 7 and cause severe neurological complications. 8 A study of the perioperative complications of pheochromocytoma resection reported that 15% of the patients developed post-excisional hypoglycemia and required intensive glucose therapy; 9 other studies reported a similar incidence of post-excisional hypoglycemia (13.3% with hypoglycemia defined as serum glucose levels <50 mg/ dL 3 and 4.2% with hypoglycemia defined as serum glucose levels <55 mg/dL 4 ) as the present study, suggesting that postexcisional 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: Discussionmentioning

confidence: 99%

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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Hypolgcaemic encephalopathy following surgery on phaeochromocytoma

Cited by 8 publications

References 13 publications

Hypoglycemia induced by excessive rebound secretion of insulin after removal of pheochromocytoma

Hypoglycemia induced by excessive rebound secretion of insulin after removal of pheochromocytoma

Hypoglycemia after resection of pheochromocytoma

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

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