Degree of catecholamine hypersecretion is the most important determinant of intra-operative hemodynamic outcomes in pheochromocytoma.
Pheochromocytoma resection is often complicated by intra-operative hypertension and post-resection hypotension. Factors associated with these hemodynamic alterations are not well defined. The aim of this study was to analyse the clinical-laboratory features associated with hemodynamic parameters during pheochromocytoma resection. Twenty-seven patients submitted to tumor resection - either open (no.=18) or video laparoscopic - between 1978-2007 were included. Nineteen received pre-operative alpha-blockers. Intra-operative hemodynamic data analysed were: maximum and minimum mean arterial blood pressure (MABP), no. of severe hypertensive (systolic BP >200 mmHg) and hypotensive episodes (MABP <60 mmHg), maximum and minimum heart rate (HR), no. of episodes of tachycardia and bradycardia, need to receive iv intra-operative treatment for hypertension and hypotension and the volume of fluids administered during surgery. Patients were 39.4+/-14.4-yr-old, 66% women. Intra-operative hemodynamic parameters were not different in patients submitted to open or video laparoscopic resection. Maximum intraoperative HR and the percentage of patients with HR>100 beats/min were higher in patients without pre-operative alpha- blocker treatment (no.=8). Pre-operative urinary vanylmandelic acid was positively associated with intra-operative maximum MABP (r=0.535, p=0.047) and with maximum transoperative systolic BP (r=0.805, p=0.016). Pre-operative urinary catecholamine (Pearson correlation r=0.575, p=0.03) and vanylmandelic acid (Pearson correlation r=0.605, p=0.04) levels were associated with maximum intra- operative MABP, adjusted for the presence of pheochromocytoma symptoms, surgical approach and pre-operative alpha-blockers. In conclusion, the degree of pre-operative catecholamine secretion was the most important aspect of transoperative BP control.
Kramer
C K
CK
Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. ckkramer@terra.com.br
Leitão
C B
CB
Azevedo
M J
MJ
Canani
L H
LH
Maia
A L
AL
Czepielewski
M
M
Paggi
A
A
Rodrigues
T C
TC
Silveiro
S P
SP
Friedman
R
R
Gross
J L
JL
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D015415:Biomarkers / Q000378:metabolism / Q000652:urine; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000378:metabolism* / Q000652:urine; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000317:Adrenergic alpha-Antagonists; D015415:Biomarkers; D002395:Catecholamines