title: Predictors of recurrence in pheochromocytoma.
abstract: BACKGROUND
  The recurrence rate of pheochromocytoma after adrenalectomy is 6.5-16.5%. This study aims to identify predictors of recurrence and optimal biochemical testing and imaging for detecting the recurrence of pheochromocytoma.
  
  
  METHODS
  In this retrospective study we reviewed all patients who underwent adrenalectomy for pheochromocytoma during a 14-year period at a single institution.
  
  
  RESULTS
  One hundred thirty-five patients had adrenalectomy for pheochromocytoma. Eight patients (6%) developed recurrent disease. The median time from initial operation to diagnosis of recurrence was 35 months. On multivariate analysis, tumor size >5 cm was an independent predictor of recurrence. One patient with recurrence died, 4 had stable disease, 2 had progression of disease, and 1 was cured. Recurrence was diagnosed by increases in plasma and/or urinary metanephrines and positive imaging in 6 patients (75%), and by positive imaging and normal biochemical levels in 2 patients (25%).
  
  
  CONCLUSIONS
  Patients with large tumors (>5 cm) should be followed vigilantly for recurrence. Because 25% of patients with recurrence had normal biochemical levels, we recommend routine imaging and testing of plasma or urinary metanephrines for prompt diagnosis of recurrence.
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Danielle
authors.initials: D
authors.lastname: Press
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Muhammet
authors.initials: M
authors.lastname: Akyuz
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Cem
authors.initials: C
authors.lastname: Dural
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Shamil
authors.initials: S
authors.lastname: Aliyev
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Rosebel
authors.initials: R
authors.lastname: Monteiro
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Jeff
authors.initials: J
authors.lastname: Mino
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Jamie
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Amir
authors.initials: A
authors.lastname: Hamrahian
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.affiliation: Departments of Endocrine Surgery and Endocrinology, Cleveland Clinic, Cleveland, OH. Electronic address: berbere@ccf.org.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000401:mortality; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D010673:Pheochromocytoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult