Preoperative Levels of Catecholamines and Metanephrines and Intraoperative Hemodynamics of Patients Undergoing Pheochromocytoma and Paraganglioma Resection

Weingarten, Toby N.; Welch, Tasha L.; Moore, Tamara L.; Walters, Gulshat F.; Whipple, Joni L.; Cavalcante, Alexandre N.; Bancos, Irina; Young, William F.; Gruber, Lucinda; Shah, Meera; McKenzie, Travis J.; Schroeder, Darrell R.; Šprung, Juraj

doi:10.1016/j.urology.2016.10.012

Cited by 57 publications

(50 citation statements)

References 20 publications

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“…In this relatively small data set we could also demonstrate a relation between level of metanephrines and the difference between highest and lowest systolic blood pressure measured during surgery (Spearman r=0.58, p=0.0008, data not shown). But, in agreement with a previous study [11], substantial variation of preoperative levels of metanephrines were seen and subjects with the highest perioperative systolic blood pressure variations had metanephrine levels below average, indicating that metanephrine levels does not alone predict hemodynamic control during operation.…”

Section: Discussionsupporting

confidence: 91%

“…Speculation on avoiding alpha-receptor pretreatment in certain groups of patients with PPGL has been raised [4,8,[16][17][18]. However, reliable predictors of hemodynamic instability are not well characterized [11,14,[19][20][21]. This study does not have power to examine risk factors for per-operative hemodynamic instability but favours high dose PBZ pretreatment for minimizing perioperative hemodynamic variability.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies have found level of catecholamine as a predictor of hemodynamic instability [11,14,22].…”

Section: Discussionmentioning

confidence: 94%

“…As pretreatment is time consuming, related with significant side-effects and carries a risk of postoperative hypotension it has been speculated to be redundant and a preoperative risk stratification of patients may be usefull [8,9]. Others concur with international guidelines recommending preoperative treatment with alpha-receptor blocker regardless the PPGL phenotype [3,10,11].…”

Section: Introductionmentioning

confidence: 99%

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Effect of High or Low Dose Phenoxybenzamine on Per-Operative Hemodynamics in Pheochromocytoma

Ugleholdt¹,

Rasmussen²,

Haderslev³

et al. 2020

Preprint

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Background. Alpha-receptor blockade is the mainstay in preoperative treatment of patients with pheochromocytoma and paraganglioma (PPGL). However, evidence regarding optimal dosage regimen is lacking. This study compares the per- and postoperative hemodynamics in patients pre-treated with a high or low dose of phenoxybenzamine. Methods. 30 consecutive patients with PPGL undergoing laparoscopic adrenalectomy were identified retrospectively. All were pretreated with phenoxybenzamine but at two separate endocrine departments aiming at different blood pressure target. End-dosage of phenoxybenzamine differed significantly between departments with 14 patients receiving a high dose regimen and 16 a low dose regimen. As a control group, we included 42 patients undergoing laparoscopic adrenalectomy for other reasons. Primary purpose was to compare per- and postoperative hemodynamics in the high and low dose groups. Secondly, to compare these endpoints to the control group. Results. Baseline characteristics did not differ between the phenoxybenzamine treated groups. The high dose group had less intra-operative systolic and diastolic blood pressure fluctuation (p = 0.03) and less periods with heart rate above 100 bpm (p = 0.04) as compared to the low dose group. Use of intravenous fluids were similar between the two groups. However, postoperatively, more intravenous fluids were administered in the high dose group. Overall, the control group was more hemodynamic stable as compared to either group treated for PPGL. Conclusions. High dose phenoxybenzamine improves per-operative hemodynamic stability but causes a higher postoperative requirement for intravenous fluids. Overall, PPGL surgery is related to greater hemodynamic instability compared to adrenalectomy for other reasons.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 94%

“…Previous studies have found level of catecholamine as a predictor of hemodynamic instability [11,14,22].…”

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of High or Low Dose Phenoxybenzamine on Per-Operative Hemodynamics in Pheochromocytoma

Ugleholdt¹,

Rasmussen²,

Haderslev³

et al. 2020

Preprint

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“…Understanding of intraoperative hemodynamic instability (IHD), intraoperative and postoperative complications and mortality are vital to successfully evaluating perioperative outcomes. To decrease the risk of IHD as well as surgical complications and mortality, all patients are recommended to undergo a preoperative medical preparation, including patients with tumors rising from parasympathetic ganglia, since they can also release significant amounts of catecholamines during surgery ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Tumor characteristics and surgical outcome in incidentally discovered pheochromocytomas and paragangliomas

Chen

Liu

et al. 2018

Endocrine Connections

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ObjectiveThe proportion of incidentally discovered pheochromocytomas and paragangliomas (PPGL) has increased over time. However, our knowledge of them is quite limited. The purpose of this retrospective study is to generalize the commonalities in incidentally discovered PPGL, offer evidence for clinical diagnosis and management.MethodsFive hundred twenty-six patients were included in our study after filtration from the database of West China Hospital of Sichuan University between May, 2007 and December, 2016. Among the patients, 148 of them were incidental findings and 378 of them were suspected findings. All patients’ demography and tumor characteristics were recorded in detail, especially hemodynamic records and hormonal assays. The reasons for taking radiography were also collected. Most patients received preoperative medical preparation. Intraoperative and postoperative courses as well as surgical outcomes were also analyzed to identify differences between incidental findings and suspected findings.ResultsIncidentally discovered PPGL took up 28.1% of the study population. Suspected PPGLs had a higher prevalence of hypertension, lower proportion of non-functioning PPGL, higher prevalence of MEN2 and better post-surgical blood pressure recovery than incidental finding group. However, patients in the incidental finding group showed no significant difference in preoperative blood pressure and hormonal assays with suspected findings in metaphrine and normetaphrine in plasma and urine (P > 0.05).ConclusionsDue to the development of technology, more PPGLs are discovered incidentally. Considering the tumor characteristics and surgical outcome, surgical decisions should be made more cautiously.

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Bladder paraganglioma: A case of acute respiratory distress syndrome triggered by large bladder tumor transurethral resection with mild symptoms and atypical imaging

et al. 2023

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Introduction Bladder paraganglioma is exceedingly rare, accounting for <0.05% of bladder tumors. This is a case of paraganglioma with no symptom other than palpitations during urination, with atypical imaging, resulting in acute respiratory distress syndrome after transurethral resection of the bladder tumor. Case presentation A 46‐year‐old man underwent transurethral resection of the bladder tumor for a bladder tumor 61 × 52 mm in size on contrast‐enhanced computed tomography. The patient only had micturition attacks and was suspected to have urothelial carcinoma on magnetic resonance imaging. The patient had acute respiratory distress syndrome after the operation which improved conservatively. The 123 Iodine metaiodobenzylguanidine scintigraphy, urinalysis, and pathological examination revealed bladder paraganglioma. Robot‐assisted radical cystectomy and ileal neobladder reconstruction were performed. Conclusion This study reported bladder paraganglioma with no symptoms other than micturition attacks in which acute respiratory distress syndrome occurred after transurethral resection of the bladder tumor.

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Preoperative Levels of Catecholamines and Metanephrines and Intraoperative Hemodynamics of Patients Undergoing Pheochromocytoma and Paraganglioma Resection

Cited by 57 publications

References 20 publications

Effect of High or Low Dose Phenoxybenzamine on Per-Operative Hemodynamics in Pheochromocytoma

Effect of High or Low Dose Phenoxybenzamine on Per-Operative Hemodynamics in Pheochromocytoma

Tumor characteristics and surgical outcome in incidentally discovered pheochromocytomas and paragangliomas

Bladder paraganglioma: A case of acute respiratory distress syndrome triggered by large bladder tumor transurethral resection with mild symptoms and atypical imaging

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