Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Postgrad Med. 2024 Apr 1;70(2):84-90. doi: 10.4103/jpgm.jpgm_208_23. Epub 2023 Aug 4.
CONTEXT/AIMS: Pheochromocytoma and paraganglioma (PPGL) are rare tumors, and data on ambulatory blood pressure monitoring (ABPM) in these patients and the effect of blocking on ABPM parameters is limited. We aimed to describe ABPM parameters in a cohort of PPGL at our center in western India.
Retrospective study of patients with PPGL whose ABPM data was available. Demographic details, secretory status, and ABPM data were retrieved. Coefficient of variability (CV) was calculated as standard deviation/mean in percentage.
In the 39 included patients, mean age at presentation was 39.3 ± 14.2 yr; 20 (51.3%) were males, 25 (64.1%) hypertensive, and mean tumor diameter was 5.3 cm. In 18 patients whose baseline ABPM was done without medications, those with nocturnal blood pressure dipping (6/18, 33%) had higher serum metanephrines (median 313.2 vs. 34.7 pg/ml, P = 0.028). Despite normal office blood pressure (BP), 8.9% of systolic BP readings were >140 mmHg, and 1.2% were >160 mmHg. Among 29 patients with both pre and post-block ABPM, mean BP (systolic 121.6 vs. 132.5 mmHg, P = 0.014; diastolic 68.9 vs. 76.4 mmHg, P = 0.005) and percentage of BP readings above 140 mmHg (median 9.4% vs. 24.4%, P = 0.016) were significantly lowered after the preoperative blockade in hypertensive ( n = 19) patients, whereas CV was similar. The post-blockade ABPM characteristics were similar in patients blocked with amlodipine or prazosin.
ABPM provides additional information about BP characteristics in PPGL. The preoperative blocking decreases the magnitude of BP excursions but does not affect BP variability.
背景/目的：嗜铬细胞瘤和副神经节瘤（PPGL）是罕见的肿瘤，关于这些患者的动态血压监测（ABPM）的数据以及阻断对 ABPM 参数的影响是有限的。我们旨在描述在我们位于印度西部的中心的一组 PPGL 患者的 ABPM 参数。
回顾性研究了 ABPM 数据可用的 PPGL 患者。检索了人口统计学细节、分泌状态和 ABPM 数据。变异系数（CV）以百分比的标准差/平均值计算。
在 39 例纳入的患者中，就诊时的平均年龄为 39.3±14.2 岁；20 例（51.3%）为男性，25 例（64.1%）为高血压，平均肿瘤直径为 5.3cm。在 18 例基线 ABPM 未用药的患者中，夜间血压下降（6/18，33%）的患者血清间甲肾上腺素水平较高（中位数 313.2 与 34.7pg/ml，P=0.028）。尽管办公室血压正常（BP），8.9%的收缩压读数>140mmHg，1.2%的读数>160mmHg。在 29 例有预、后阻断 ABPM 的患者中，平均 BP（收缩压 121.6 与 132.5mmHg，P=0.014；舒张压 68.9 与 76.4mmHg，P=0.005）和高于 140mmHg 的 BP 读数百分比（中位数 9.4%与 24.4%，P=0.016）在高血压（n=19）患者术前阻断后显著降低，而 CV 相似。在使用氨氯地平或哌唑嗪阻断的患者中，阻断后的 ABPM 特征相似。
ABPM 提供了关于 PPGL 血压特征的额外信息。术前阻断降低了 BP 波动幅度，但不影响 BP 变异性。
