Furnica Raluca Maria, Dusoruth Muhammad Muddaththir, Persu Alexandre, Gruson Damien, Mourad Michel, Maiter Dominique
Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Endocr Connect. 2021 Jan;10(1):92-101. doi: 10.1530/EC-20-0537.
Surgery of pheochromocytomas (PCs) still carries a high risk of haemodynamic complications during the perioperative period. We aimed to evaluate the influence of their secretory phenotype and preoperative alpha-blocker treatment on surgical outcome.
A retrospective monocentric study at a tertiary medical centre.
In this study, 80 consecutive patients operated by the same team for a PC between 1988 and 2018.
Diagnosis was based on typical symptoms and signs in 58 patients, genetic testing in 12 and work-up of an adrenal incidentaloma in 9. It was made during surgery in one patient. A genetic predisposition was found in one-third of index cases (21/62). The majority of the patients (73/79) had a secreting PC; more than 2/3 had an adrenergic phenotype and less than 1/3 a noradrenergic phenotype. The rate of perioperative haemodynamic complications was not influenced by the secretory phenotype, but persistent hypertension after surgery, recurrence and malignancy were more frequently observed in patients with a noradrenergic tumour. Preoperative alpha-blocker treatment was given for ≥ 14 days in 29 patients and, although being more symptomatic at diagnosis, these patients had less haemodynamic complications (3/29 vs 12/51 non-treated patients, P = 0.05).
The occurrence of haemodynamic complications during surgery was not significantly affected by the secretory phenotype in our study, but noradrenergic tumours show a worse post-surgical outcome. Our data also provide additional support in favour of a sufficient preoperative alpha-blockade in patients with pheochromocytoma.
嗜铬细胞瘤（PC）手术在围手术期仍具有较高的血流动力学并发症风险。我们旨在评估其分泌表型和术前α受体阻滞剂治疗对手术结果的影响。
在一家三级医疗中心进行的回顾性单中心研究。
本研究纳入了1988年至2018年间由同一团队为PC进行手术的80例连续患者。
58例患者根据典型症状和体征确诊，12例通过基因检测确诊，9例通过肾上腺偶发瘤检查确诊。1例患者在手术期间确诊。三分之一的索引病例（21/62）发现有遗传易感性。大多数患者（73/79）患有分泌型PC；超过2/3具有肾上腺素能表型，不到1/3具有去甲肾上腺素能表型。围手术期血流动力学并发症的发生率不受分泌表型的影响，但去甲肾上腺素能肿瘤患者术后持续性高血压、复发和恶性肿瘤的发生率更高。29例患者术前接受了≥14天的α受体阻滞剂治疗，尽管这些患者在诊断时症状更明显，但血流动力学并发症较少（29例治疗患者中有3例，51例未治疗患者中有12例，P = 0.05）。
在我们的研究中，手术期间血流动力学并发症的发生不受分泌表型的显著影响，但去甲肾上腺素能肿瘤的手术结果较差。我们的数据也为嗜铬细胞瘤患者术前充分的α受体阻滞剂治疗提供了额外支持。
