title: Risk factors for hypertensive attack during pheochromocytoma resection.
abstract: We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge.
  
  
  
  Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed.
  
  
  
  In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d.
  
  
  
  In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma.
authors.affiliation: Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea.
authors.forename: Se Yun
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea.
authors.forename: Kyung Seop
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jun Nyung
authors.initials: JN
authors.lastname: Lee
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Yun-Sok
authors.initials: YS
authors.lastname: Ha
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Seock Hwan
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Hyun Tae
authors.initials: HT
authors.lastname: Kim
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Eun Sang
authors.initials: ES
authors.lastname: Yoo
authors.affiliation: Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kwon
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects*; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000652:urine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002395:Catecholamines
keywords: Adrenalectomy; Catecholamine; Hypertension; Pheochromocytoma