title: Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas.
abstract: BACKGROUND
  The per-operative hemodynamic behavior of normotensive incidentally discovered pheochromocytomas is poorly documented.
  
  
  OBJECTIVE
  To compare the per-operative hemodynamic instability and early postoperative outcome of normotensive pheochromocytomas, hypertensive pheochromocytomas, and benign non-pheochromocytoma adrenal incidentalomas (AIs).
  
  
  METHODS
  Retrospective cohort treated in a single center.
  
  
  METHODS
  Fifty patients (10 normotensive pheochromocytomas, 24 hypertensive pheochromocytomas, and 16 AIs) were anesthetized and operated on by the same team, using laparoscopy in 78% of cases. Before surgery, 60% of normotensive and 95.8% of hypertensive pheochromocytomas received pretreatment with α-receptor or calcium channel blockers. All of the patients received the same intraoperative hemodynamic monitoring, including continuous direct intra-arterial pressure recording.
  
  
  RESULTS
  All the features of hemodynamic instability, with the exception of the diastolic pressure nadir and fluid volume requirements, differed between hypertensive pheochromocytomas and AIs. Conversely, all features of hemodynamic instability were similar in hypertensive and normotensive pheochromocytomas. More specifically, by comparison with AIs, normotensive pheochromocytomas displayed higher maximal systolic pressure; more hypertensive, severe hypertensive, and hypotensive episodes; and a higher minimal heart rate, and also required more interventions to treat undesirable blood pressure elevations. Postoperative complications, all of which were mild, were more frequent in hypertensive pheochromocytomas than in normotensive pheochromocytomas (P < .03).
  
  
  CONCLUSIONS
  Normotensive pheochromocytomas have roughly comparable per-operative hemodynamic instability to hypertensive pheochromocytomas and differ markedly from non-pheochromocytoma AIs. It is therefore crucial to identify normotensive pheochromocytomas among AIs when surgery is scheduled and to apply the standard of care for pheochromocytoma anesthesia.
authors.affiliation: Departments of Endocrinology (M.L., M.H., A.T.), Anesthesiology (G.D.), Endocrine Surgery (T.W.), and Nuclear Medicine (J.B.C.), Centre Hospitalier Universitaire (CHU) Bordeaux and University of Bordeaux, 33604 Pessac, France; and Department of Endocrinology (C.F.), CHU Fort-de-France, 97261 Fort-de-France, Martinique.
authors.forename: M
authors.initials: M
authors.lastname: Lafont
authors.forename: C
authors.initials: C
authors.lastname: Fagour
authors.forename: M
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: G
authors.initials: G
authors.lastname: Darancette
authors.forename: T
authors.initials: T
authors.lastname: Wagner
authors.forename: J B
authors.initials: JB
authors.lastname: Corcuff
authors.forename: A
authors.initials: A
authors.lastname: Tabarin
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000503:physiopathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies