Investig Clin Urol.  2016 May;57(3):184-190. 10.4111/icu.2016.57.3.184.

Risk factors for hypertensive attack during pheochromocytoma resection

• Kwon SY
• Lee KS
• Lee JN
• Ha YS
• Choi SH
• Kim HT
• Kim TH
• Yoo ES
• Kwon TG

• KMID: 2426492
• DOI: http://doi.org/10.4111/icu.2016.57.3.184

Abstract

PURPOSE
We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge.
MATERIALS AND METHODS
Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed.
RESULTS
In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d.
CONCLUSIONS
In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma.

Keyword

Adrenalectomy; Catecholamine; Hypertension; Pheochromocytoma

MeSH Terms

Adrenal Gland Neoplasms/physiopathology/*surgery
Adrenalectomy/*adverse effects
Adult
Blood Pressure/physiology
Catecholamines/urine
Female
Humans
Hypertension/*etiology/physiopathology/urine
Intraoperative Complications
Male
Middle Aged
Pheochromocytoma/physiopathology/*surgery
Prognosis
ROC Curve
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Receiver operating characteristic (ROC) curve of multiple cutoff values of tumor size and preoperative epinephrine.

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