Department of Surgery, University of Chicago, Chicago Illinois.
Department of Surgery, University of Chicago, Chicago Illinois.
J Surg Res. 2024 Jun;298:88-93. doi: 10.1016/j.jss.2024.03.004. Epub 2024 Apr 8.
Elevated metanephrine and catecholamine levels 3-fold upper limit of normal (ULN) are diagnostic for pheochromocytoma. We sought to determine whether size correlates with biochemical activity or symptoms which could guide timing of surgery.
Data from consecutive patients undergoing adrenalectomy for pheochromocytoma at our institution over a 10-year period were retrospectively collected. These included maximal lesion diameter on preoperative imaging, plasma/urine metanephrine and/or catecholamine levels, demographic variables and presence of typical paroxysmal symptoms. Receiver operating characteristic curves were used to assess predictive accuracy.
Sixty-three patients were included in the analysis (41 females and 22 males). Median age was 56 (43, 69) years. Due to various referring practices, 31 patients had documented 24-h urine metanephrine, 26 had 24-h urine catecholamine, and 52 had fractionated plasma metanephrine levels available for review. Values were converted to fold change compared to ULN and the maximum of all measured values was used for logistic regression. Median tumor size was 3.40 (2.25, 4.55) cm in greatest dimension. Tumor size at which pheochromocytoma produced > 3-fold ULN was ≥2.3 cm (AUC of 0.84). Biochemical activity increased with doubling tumor size (odds ratio = 8, P = 0.0004) or ≥ 1 cm increase in tumor size (odds ratio = 3.03, P = 0.001). 40 patients had paroxysmal symptoms, but there was no significant correlation between tumor size/biochemical activity and symptoms.
In our study, tumor size directly correlated with the degree of biochemical activity and pheochromocytomas ≥2.3 cm produced levels 3 times ULN. These findings may allow clinicians to adjust timing of operative intervention.
升高的间甲肾上腺素和儿茶酚胺水平达到正常值上限的 3 倍（ULN）是嗜铬细胞瘤的诊断标准。我们试图确定大小是否与生化活性或症状相关，这些可以指导手术时机。
回顾性收集了我院在过去 10 年期间因嗜铬细胞瘤接受肾上腺切除术的连续患者的数据。这些数据包括术前影像学上最大病变直径、血浆/尿液间甲肾上腺素和/或儿茶酚胺水平、人口统计学变量以及典型阵发性症状的存在。使用接收者操作特征曲线评估预测准确性。
共有 63 名患者纳入分析（41 名女性和 22 名男性）。中位年龄为 56（43，69）岁。由于各种转诊实践，31 名患者有记录的 24 小时尿间甲肾上腺素，26 名患者有 24 小时尿儿茶酚胺，52 名患者有可用于回顾的分馏血浆间甲肾上腺素水平。将这些值转换为与 ULN 的倍数变化，并使用所有测量值中的最大值进行逻辑回归。肿瘤最大直径的中位数为 3.40（2.25，4.55）cm。嗜铬细胞瘤产生> 3 倍 ULN 的肿瘤大小为≥2.3 cm（AUC 为 0.84）。生化活性随着肿瘤大小的翻倍增加（优势比= 8，P = 0.0004）或肿瘤大小增加≥1 cm 而增加（优势比= 3.03，P = 0.001）。40 名患者有阵发性症状，但肿瘤大小/生化活性与症状之间无显著相关性。
在我们的研究中，肿瘤大小与生化活性的程度直接相关，≥2.3 cm 的嗜铬细胞瘤产生的水平为正常值上限的 3 倍。这些发现可能使临床医生能够调整手术干预的时机。
