The Role of Cortisol Secretion in Pheochromocytomas and Paragangliomas: Clinical and Perioperative Implications

Abstract

Background Pheochromocytomas and paragangliomas (PPGLs) are tumors marked by excessive catecholamine secretion. Patients with pheochromocytomas may have elevated plasma glucocorticosteroid concentrations. This study aimed to evaluate the prevalence, clinical implications, and perioperative outcomes of autonomous cortisol secretion in patients with PPGLs. Design This was a retrospective cohort study conducted across 2 tertiary endocrinology centers, including patients with PPGLs who underwent adrenalectomy or extra-adrenal surgery for paragangliomas. Methods Patients were divided based on the 1-mg dexamethasone suppression test (DST) results into suppressive and nonsuppressive groups (above or below 1.8 µg/dL [50 nmol/L]). Data on clinical characteristics, biochemical markers, tumor features, perioperative outcomes, and follow-up were analyzed. Results Among 106 patients, 24.5% exhibited nonsuppressive cortisol concentrations post-DST. These patients were older (median age: 66 vs 56 years, P