Influence of secretory phenotype and preoperative preparation on surgical outcome in pheochromocytoma

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Abstract

Objectives: Surgery of pheochromocytomas (PCs) still carries a high risk of haemodynamic complications during the perioperative period. We aimed to evaluate the influence of their secretory phenotype and preoperative alpha-blocker treatment on surgical outcome. Design: A retrospective monocentric study at a tertiary medical centre. Patients: In this study, 80 consecutive patients operated by the same team for a PC between 1988 and 2018. Results: Diagnosis was based on typical symptoms and signs in 58 patients, genetic testing in 12 and work-up of an adrenal incidentaloma in 9. It was made during surgery in one patient. A genetic predisposition was found in one-third of index cases (21/62). The majority of the patients (73/79) had a secreting PC; more than 2/3 had an adrenergic phenotype and less than 1/3 a noradrenergic phenotype. The rate of perioperative haemodynamic complications was not influenced by the secretory phenotype, but persistent hypertension after surgery, recurrence and malignancy were more frequently observed in patients with a noradrenergic tumour. Preoperative alpha-blocker treatment was given for ≥ 14 days in 29 patients and, although being more symptomatic at diagnosis, these patients had less haemodynamic complications (3/29 vs 12/51 non-treated patients, P = 0.05). Conclusions: The occurrence of haemodynamic complications during surgery was not significantly affected by the secretory phenotype in our study, but noradrenergic tumours show a worse post-surgical outcome. Our data also provide additional support in favour of a sufficient preoperative alpha-blockade in patients with pheochromocytoma.

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Furnica, R. M., Dusoruth, M. M., Persu, A., Gruson, D., Mourad, M., & Maiter, D. (2021). Influence of secretory phenotype and preoperative preparation on surgical outcome in pheochromocytoma. Endocrine Connections, 10(1), 92–101. https://doi.org/10.1530/EC-20-0537

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