Hypertension and hypertensive cardiomyopathy in patients with a relapse‐free history of phaeochromocytoma

Weismann, Dirk; Liu, Dan; Bergen, Till; Peitzsch, Mirko; Raida, Anna; Wagner, Martin; Fassnacht, Martin; Weidemann, Frank; Allolio, Bruno

doi:10.1111/cen.12536

Cited by 6 publications

(8 citation statements)

References 33 publications

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“…However, the paraganglioma group received the same amount of antihypertensive medication post surgery as at diagnosis, despite normalization of blood pressure. Our improvement in blood pressure seems much better than others who have shown persistent hypertension in 51–79% at last follow-up [ 9 , 10 ]. Weismann et al [ 10 ] reported that only 38% had improved blood pressure using similar criteria as us, compared to 94% of our patients.…”

Section: Discussioncontrasting

confidence: 57%

“…Our improvement in blood pressure seems much better than others who have shown persistent hypertension in 51–79% at last follow-up [ 9 , 10 ]. Weismann et al [ 10 ] reported that only 38% had improved blood pressure using similar criteria as us, compared to 94% of our patients. On the other hand, our blood pressure follow-up was done 6–12 months post surgery, and we did not have long-term follow-up data of blood pressure.…”

Section: Discussioncontrasting

confidence: 57%

“…On the other hand, our blood pressure follow-up was done 6–12 months post surgery, and we did not have long-term follow-up data of blood pressure. Our patients were probably not as symptomatic, since less than a third presented with suspicion of PPGL, compared to 57 to >85% reported by the other research groups [ 9 , 10 , 20 ]. Nevertheless, all our patients in the symptomatic PPGL group also had blood pressure improvement by surgery.…”

Section: Discussioncontrasting

confidence: 52%

“…Hypertension, paroxysmal or consistent, is very common and metabolic disturbances, such as diabetes, are fairly prevalent [ 1 , 8 ]. In a large proportion of patients, hypertension has been reported to persist after surgery [ 9 , 10 ], while metabolic derangements were more likely to improve [ 11 ]. Occasionally, both diabetes and hypertension resolve after surgery, although it is unclear how often.…”

Section: Introductionmentioning

confidence: 99%

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Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center

2018

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PurposeMany pheochromocytomas and paragangliomas (PPGLs) are nowadays diagnosed as incidentalomas or by screening. This may have changed outcomes.MethodsWe reviewed 110 consecutive cases of PPGLs. Two cases with concurrent ectopic ACTH-syndrome were excluded.ResultsSixty-five percent had presented as incidentalomas, 30% as symptomatic PPGLs, and 5% had been screened (previously diagnosed MEN2A). Doxazosin was used in 79%, phenoxybenzamine in 18%, intravenous phentolamine in 1%, and no alpha-blockade in the rest. Laparoscopic surgery was performed in 70%, but 11% were converted to open surgery. Complications of surgery were seen in 20%, and length of stay after surgery was 4 days (2–8) with no correlation with alpha-blockade dose or time. In the whole cohort glycemic disturbances decreased by surgery (47% vs. 9%, P < 0.001). During 9.6 ± 7.2-year (median 8[4–13]) follow-up, 7% developed a new PPGL, 5% a PPGL-metastasis (KI67 > 2% n = 2; KI67 ≤ 1% n = 3; tumor size ≥ 95 mm n = 4), and 13% died (metastatic pheochromocytoma n = 2, hypertensive crisis n = 1, heart failure n = 2, other malignancies n = 5, and unclear n = 4). Surgery improved blood pressure and glycemic disturbances in the incidentaloma and the symptomatic PPGL. Recurrence was more common in the screening group. The symptomatic PPGL group was more likely to die of a PPGL-related cause. Surgery was more challenging in the paragangliomas, with less improvement in glycemic control than in the pheochromocytoma group. However, blood pressure and long-term outcomes were similar.ConclusionThe outcomes seemed slightly better than previous studies. Long-term prognosis was similar between pheochromocytomas and paragangliomas.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussioncontrasting

confidence: 57%

Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center

2018

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“…The diagnosis may be challenging as about 50% of patients are asymptomatic [ 10 ] or suffer from only unspecific signs or symptoms [ 9 , 11 ]. On the other hand, up to 20% may develop life-threatening hemodynamic instability leading to pulmonary edema, malignant arrhythmias, myocardial infarction, stroke, or sudden death [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Measurements of Plasma-Free Metanephrines by Immunoassay Versus Urinary Metanephrines and Catecholamines by Liquid Chromatography with Amperometric Detection for the Diagnosis of Pheochromocytoma/Paraganglioma

Raber

Kotal

Marculescu

et al. 2020

JCM

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Studies conflict concerning the use of enzyme immunoassays (EIA) for plasma free metanephrines (P-MNs) vs. other methods for pheochromocytoma/paraganglioma (PPGL) diagnosis. We compared commercially available EIAs for P-MNs with high-pressure liquid chromatography (HPLC) for 24 h-urinary MNs (U-MNs) and -catecholamines (U-CATs). 943 (565 female, 378 male) patients (54 PPGL, 889 Non-PPGL) were studied. Simultaneous measurements of all parameters analyzed at the central lab of our university hospital was mandatory for inclusion. Sensitivity of P-MNs (94.4%) was similar to that of U-MNs (100%), and both were higher than of U-CATs (77.8%), specificity of P-MNs (100%) higher than of U-MNs (73.6%), and similar to U-CATs (99.8%). With the recently proposed downward adjusted ULN of P-MNs to correct for the reported negative bias of the EIAs sensitivity (98.1%) raised non-significantly, but specificity decreased significantly (94.8%). Areas under receiver-operating characteristic curves indicated comparable diagnostic performance of P-MNs (0.989) vs. U-MNs (0.995), both better than U-CATs (0.956). In summary, the EIAs to measure P-MNs performed similarly to U-MNs by HPLC, and both better than U-CATs by HPLC. The post-test probability of PPGL given a positive test result was best for P-MNs, and higher than for the other pairs of analytes. Downward corrections of ULN of P-MNs did not improve test performances.

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Echocardiography in Nutritional and Metabolic Disorders

Linefsky¹

2017

Practice of Clinical Echocardiography

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Hypertension and hypertensive cardiomyopathy in patients with a relapse‐free history of phaeochromocytoma

Abstract: Our data indicate that hypertension persists after removal of PCG/PGL in a substantial proportion of patients. Hypertensive heart disease is common, and cardiovascular events are frequent in patients with a history of PCC/PGL.

Cited by 6 publications

References 33 publications

Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center

Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center

Measurements of Plasma-Free Metanephrines by Immunoassay Versus Urinary Metanephrines and Catecholamines by Liquid Chromatography with Amperometric Detection for the Diagnosis of Pheochromocytoma/Paraganglioma

Echocardiography in Nutritional and Metabolic Disorders

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