Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion / sensitivity and predictors of remission

Khatiwada, Saurav; Agarwal, Shipra; Kandasamy, Devasenathipathy; Jyotsna, Viveka P; Kumar, Rajeev; Bansal, Virinder Kumar; Pandey, Ravindra Mohan; Gupta, Nidhi; Tandon, Nikhil

doi:10.1016/j.dsx.2020.10.030

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…In our study, 22.2% of the participants had DM, which corresponds to previously published data ( 15 , 25 , 26 ). Some researchers have suggested the pathogenesis of DM in PPGL is multifactorial and includes impaired insulin secretion and insulin deficiency, defects in insulin signalling and response, as well as increase endogenous glucose production and impaired exogenous glucose uptake ( 27 ).…”

Section: Discussionsupporting

confidence: 92%

Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

et al. 2022

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BackgroundCatecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations. Although there are reviews of reported cases, these reviews lack detailed data, which makes it impossible to perform an accurate analysis. In this study, we conducted a comprehensive analysis of cardiovascular complications (CCs), including PPGL-related myocardial injury, cardiogenic shock, and arrhythmias requiring antiarrhythmic therapy, in a large cohort of patients with PPGL.MethodsWe retrospectively analyzed the clinical data of consecutive patients with PPGL admitted between January 2018 and June 2020. The prevalence and the characteristics of patients with CCs were investigated. Moreover, comparisons were made between patients with and without CCs.ResultsCompared with the non-CC group, the percentage of men was significantly lower (14/41 vs.92/175, 34.1% vs. 52.6%, p = 0.034) and the proportion of patients with paroxysmal hypertension was significantly higher (13/41 vs.29/173, 31.7% vs.16.8%, p = 0.03) in the CC group. More patients showed excessive sweating (19/41 vs 64/175, 46.3% vs. 24.0%, p = 0.004) and PPGL crisis (7/41 vs. 10/175, 17.1% vs.5.7%, p=0.035) in the CC group. In terms of laboratory findings, higher white blood cell [7.36 (6.49, 20.23) vs. 5.95 (5.1, 6.97)×109/L, p<0.001] and platelet [339.28 ± 108.54 vs. 250.66 ± 70.83(×109/L), p = 0.021] counts were more common in the CC group. There was also a higher prevalence of combination-producing PPGL in the CC group (13/24 vs.20/149, 54.2% vs.13.4%, p<0.001). However, the tumor size, invasive behavior on histology, and hemorrhage or necrosis on histology did not differ between the two groups. Platelet count [odds ratio (OR): 1.009; 95% confidence interval (CI) 1.001–1.016; p=0.023] and combination-secreting PPGL (OR: 5.009; 95% CI 1.365–18.38; p=0.015) are independent risk factors for CCs in patients with PPGL.ConclusionsIn patients with PPGL, even in the absence of signs and symptoms of CCs, a work up of cardiology should be strongly considered. Importantly, if patients with PPGLs have higher platelet counts and the combination-secreting pattern, they are more likely to have CCs. Thus, a careful cardiac evaluation should be performed.

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Section: Discussionsupporting

confidence: 92%

Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

et al. 2022

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“…In our study, hypertension and diabetes were less frequent in the negative catecholamine group than the positive catecholamine group, which was expected owing to the effect of catecholamines on blood pressure and glucose metabolism [ 27 , 28 , 29 ]. Catecholamines also affect body weight during hypermetabolic and proinflammatory states [ 30 ].…”

Section: Discussionmentioning

confidence: 67%

The Clinical Characteristics of Pheochromocytomas and Paragangliomas with Negative Catecholamines

Zhao

Zhang

Meng

et al. 2022

JCM

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Pheochromocytomas and paragangliomas (PPGLs) associated with negative catecholamines are not uncommon. However, few studies have examined clinical features of patients with these tumors. In the absence of available data, it is difficult to identify characteristics of patients with potential PPGLs and normal serum and urine screens. Therefore, an analysis of patients with PPGLs was conducted retrospectively to compare the clinical features of patients with positive and negative catecholamines. This study included 214 patients, including 69 patients with negative catecholamines. Prevalence rates of diabetes (p < 0.001) and hypertension (p < 0.001) were lower and tumor diameter (p < 0.001) was smaller in the negative-catecholamine group compared with the positive-catecholamine group. Multivariable logistic regression analysis showed that extra-adrenal PPGLs were independently positively associated with negative catecholamines (p = 0.004); hypertension (p = 0.001) and tumor diameter (p = 0.016) were independently negatively associated with negative catecholamines. There was no significant difference in tumor recurrence between the two groups (mean follow-up, 20.54 ± 11.83 months) (p = 0.44). The results demonstrated that PPGL patients with negative catecholamines were more likely to have extra-adrenal tumors and less likely to have comorbidities, and these patients should also be closely monitored for tumor recurrence.

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“…This might be due to adrenaline's high affinity for α2 receptors to stimulate pancreatic β-cells, leading to reduced insulin secretion, and noradrenaline's high affinity for α1 and β3 receptors to stimulate pancreatic α-cells and adipocytes, leading to increased glucagon and free fatty acids (FFAs) levels, thus increasing hepatic glycogen synthesis and breakdown. [40] Recent studies indicate that the risk factors for preoperative glucose abnormalities include older age, [37,[41][42][43] hypertension comorbidity, [42][43][44] symptomatic tumors, [42,45,46] longer disease duration, [37] larger tumor size, [42] 24-hour urinary norepinephrine [37,43] or epinephrine levels, [43] and sporadic PPGL [44] (Table 2). Additionally, following tumor removal, many patients with PPGL experience recovery or partial relief of impaired glucose tolerance.…”

Section: Catecholamines Enhance Substance Metabolism In Patients With...mentioning

confidence: 99%

Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review

Yang,

Zhou,

Zhao

et al. 2024

Medicine

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Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with diverse clinical presentations. Alterations in energy expenditure state are commonly observed in patients with PPGL. However, the reported prevalence of hypermetabolism varies significantly and the underlying mechanisms and implications of this presentation have not been well elucidated. This review discusses and analyzes the factors that contribute to energy consumption. Elevated catecholamine levels in patients can significantly affect substance and energy metabolism. Additionally, changes in the activation of brown adipose tissue (BAT), inflammation, and the inherent energy demands of the tumor can contribute to increased resting energy expenditure (REE) and other energy metabolism indicators. The PPGL biomarker, chromogranin A (CgA), and its fragments also influence energy metabolism. Chronic hypermetabolic states may be detrimental to these patients, with surgical tumor removal remaining the primary therapeutic intervention. The high energy expenditure of PPGL has not received the attention it deserves, and an accurate assessment of energy metabolism is the cornerstone for an adequate understanding and treatment of the disease.

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Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion / sensitivity and predictors of remission

Cited by 11 publications

References 16 publications

Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

The Clinical Characteristics of Pheochromocytomas and Paragangliomas with Negative Catecholamines

Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review

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