| Hemodynamic instability during resection of pheochromocytoma in MEN versus non-MEN patients. | |
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MedLine Citation:
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PMID: 21498631 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objective: Hemodynamic (HD) instability still underlies difficulties during pheochromocytoma resection. Little is known about HD instability in patients with multiple endocrine neoplasia (MEN) type 2-related pheochromocytoma. Our aim was to assess differences in hemodynamics during pheochromocytoma resection between MEN2 and non-MEN patients. In addition, we sought to identify risk factors for intraoperative HD instability. Design: retrospective cohort study Methods: 22 MEN2 and 34 non-MEN patients underwent 61 pheochromocytoma resections at the University Medical Center Utrecht between 2000 and 2010. All MEN2-related pheochromocytomas were diagnosed through annual screening. HD instability was assessed by measuring the frequency of hypotensive (mean arterial BP (MABP) <60 mmHg) and/or hypertensive (systolic arterial BP (SABP) >200 mmHg) episodes. Results: Compared to non-MEN patients, MEN2 patients were younger at diagnosis, had less symptoms, lower hormone levels and smaller tumors. Intraoperatively, MEN2 patients had a similar frequency of hypertensive episodes (1.3 versus 1.9, p=0.162, -6.7-35.4 95%CI) and a similar maximum SABP (200 versus 220 mmHg, p=0.180, -9.7-50.5 95%CI). However, MEN2 patients experienced less frequent (1.04 versus 2.6, p=0.003, 0.57-2.6 95%CI) and less severe hypotensive episodes after tumor resection (lowest MABP: 52.5 versus 45.6 mmHg, p=0.015, -12.6--1.16 95%CI). Tumor size was an independent risk factor for HD instability for the total group after multivariate analysis. Conclusion: MEN2 patients with pheochromocytoma, despite their smaller tumors, do not distinguish themselves from non-MEN patients in terms of hypertensive episodes during pheochromocytoma resection. Therefore, pretreatment with alfa-and beta-blockade remains the standard of care in MEN2- as well as in non-MEN related pheochromocytoma. |
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Authors:
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Anouk Scholten; Menno R Vriens; Geertjan Cromheecke; Inne Hm Borel Rinkes; Gerlof D Valk |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-4-15 |
Journal Detail:
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Title: European journal of endocrinology / European Federation of Endocrine Societies Volume: - ISSN: 1479-683X ISO Abbreviation: - Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-4-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9423848 Medline TA: Eur J Endocrinol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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A Scholten, Surgery, University Medical Center Utrecht, Utrecht, 3584CX, Netherlands. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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