Predictors of Perioperative Hypertensive Crisis in Patients With Pheochromocytoma: A Retrospective Study

Abstract

Background: Pheochromocytoma is a rare adrenal gland tumor. The definitive treatment is an adrenalectomy. Because of its secretory nature, appropriate preoperative treatment is essential to prevent hypertensive crisis (HTC) during surgery. Despite this management, HTC is common and can cause life-threatening complications. We aimed to study variables that may affect HTC despite preoperative management.

Methods: In a retrospective study, among 126 medical records of patients with adrenal tumors who were referred to Alzahra Hospital, Isfahan, Iran, between 2013 and 2021, 52 patients who took proper preparation for surgery were included.

Results: Analysis of these patients (aged 15 - 72 years, 30 females) showed that 12 patients (23.1%) experienced HTC. The mean age in the HTC group was 44.0 15.3 and in the non-HTC group was 45.6 13.2 (P = 0.724). Among many potential predictors, we observed in a multivariate analysis that patients with tumors size > 33.5 mm were at higher risk for experiencing HTC (P = 0.038, odds ratio (OR): 13.1, confidence interval (CI): 1.26 - 135.26); taking amlodipine to help reduce blood pressures (BPs) was another significant predictor (P = 0.05, OR: 5.1, CI: 0.97 - 56.74). Mean values of systolic BP (SBP) and diastolic BP (DBP) before surgery in the HTC group were more, although it was not statistically significant. Patients past medical history, 24-h urine metanephrine, normetanephrine, epinephrine, norepinephrine, vanillymandelic acid (VMA), and surgical technique were not significantly distributed between HTC and non-HTC patients (P > 0.05).

Conclusion: Tumor sizes > 33.5 mm and the necessity of administering amlodipine to control BP were predictors of HTC. Due to the rarity of pheochromocytoma, multicenter studies with larger sample sizes for providing more reliable results are suggested.

J Endocrinol Metab. 2023;13(1):20-32
doi: https://doi.org/10.14740/jem853