Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

Abstract

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.

Glucocorticoid Excess in Patients with Pheochromocytoma Compared with Paraganglioma and Other Forms of Hypertension

“…This could be of importance, especially pre- and postoperatively, as severe hypoglycemia has been described postoperatively in 1 of those cases ( 30 ). Although hypoglycemia is a frequent postoperative complication in patients with pheochromocytoma, commonly thought to reflect the abrupt postresection fall in circulating catecholamines ( 31 ), it is possible that postoperative changes in glucocorticoids could also be a complicating factor. In this context, it was important to investigate whether plasma glucocorticoid concentrations decrease after successful surgery.…”

Glucose Intolerance on Phaeochromocytoma and Paraganglioma—The Current Understanding and Clinical Perspectives

“…This postoperative hypoglycemia is likely due to a sharp decrease of catecholamines by tumor extirpation (18). Recently, Araki and co-workers showed patients who had higher epinephrine and those who had glucose intolerance preoperatively were more likely to develop postoperative hypoglycemia, which indicated patients with higher epinephrine and glucose intolerance must be careful observation in the perioperative period (19).…”

Glycemic Disturbances in Pheochromocytoma and Paraganglioma

“…Wilkins confirmed occurrence of hypoglycemia in the immediate post-operative period following resection of a pheochromocytoma [28]. Hypoglycemia may occur with no discernible difference between adrenal and extra-adrenal pheochromocytomas regarding its propensity [29].…”

“…Akiba reported severe hypoglycemia in 13% of pheochromocytoma patients, usually two to 4.5 hours after surgery [34]. Patients with higher preoperative urinary epinephrine, but not norepinephrine, and those with either diabetes mellitus or impaired glucose tolerance were more likely to develop postoperative hypoglycemia [29]. Pheochromocytoma and paragangliomas may be linked to multiple endocrine neoplasia (MEN) type 2, von Hippel-Lindau (VHL) disease, and neurofibromatosis type 1 (NF1).…”