Prolonged hypoglycaemia following surgical removal of phaeochromocytoma

Jude, Edward B.; Sridhar, C. B.

doi:10.1136/pmj.76.891.39

Cited by 16 publications

(6 citation statements)

References 5 publications

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“…Post‐excisional hypoglycemia is a unique complication of catecholamine‐secreting tumors, including pheochromocytoma. Although most patients recover quickly with intravenous glucose therapy, careful monitoring is mandatory, because hypoglycemia could be prolonged or recurrent and cause severe neurological complications . A study of the perioperative complications of pheochromocytoma resection reported that 15% of the patients developed post‐excisional hypoglycemia and required intensive glucose therapy; other studies reported a similar incidence of post‐excisional hypoglycemia (13.3% with hypoglycemia defined as serum glucose levels <50 mg/dL and 4.2% with hypoglycemia defined as serum glucose levels <55 mg/dL) as the present study, suggesting that post‐excisional hypoglycemia is a common complication after surgery for pheochromocytoma.…”

Section: Discussionsupporting

confidence: 76%

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

et al. 2018

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Objectives To determine the incidence and preoperative risk factors of post‐excisional hypoglycemia in patients undergoing pheochromocytoma resection. Methods Patients who underwent surgical resection of pheochromocytoma at a single institution were retrospectively enrolled in the present study. The primary end‐point was the development of post‐excisional hypoglycemia; that is, a serum glucose level <70 mg/dL. The serum levels of immunoreactive insulin and glucose levels during the preoperative oral glucose‐tolerance test and surgery were analyzed to elucidate the mechanism of hypoglycemia. Results A total of 49 patients underwent surgical resection of pheochromocytoma, of which 21 patients (43%) developed post‐excisional hypoglycemia. The incidence of hypoglycemia was not statistically different between patients with adrenal tumors and those with extra‐adrenal tumors (18/41 [44%] vs 3/8 [38%], respectively, P = 0.73). There was no difference in the immunoreactive insulin/glucose ratio during the preoperative oral glucose‐tolerance test between patients with and those without post‐excisional hypoglycemia. The intraoperative immunoreactive insulin/glucose ratio was significantly higher in patients with hypoglycemia than in those without hypoglycemia. A higher 24‐h urinary epinephrine level, but not norepinephrine level, was a predictive factor for post‐excisional hypoglycemia. Conclusions Post‐excisional hypoglycemia is a frequent complication of pheochromocytoma resection, irrespective of the tumor location, and might be common in patients with epinephrine‐predominant tumors. All patients undergoing resection of adrenal and extra‐adrenal pheochromocytoma require intensive monitoring of serum glucose levels during and after surgery.

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Section: Discussionsupporting

confidence: 76%

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

et al. 2018

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“…Its onset is immediate and recovery occurs within 1-2 min (56). It is often used as a first choice agent to treat intraoperative arterial pressure increases in patients undergoing pheochromocytoma removal (6,16,30). In patients with coronary artery disease, a significant 'steal' in coronary blood flow has been documented (56).…”

Section: Intraoperative Hypotensive Drugsmentioning

confidence: 99%

“…The release of both catecholamine types stimulates b1-adrenoreceptors resulting in an increased heart rate (1,2,5). Elevated blood glucose level is primarily due to stimulation of lipolysis and inhibition of glucose uptake in muscle cells and also to glycogenolysis and gluconeogenesis in the liver by epinephrine (1,6,7). Depending on whether catecholamines are released continuously or in shorter bursts, patients will mainly have sustained high blood pressure or a classical presentation consisting of paroxysmal episodes of hypertension associated with headache, sweating, chest pain, tachyarrhythmia, diaphoresis, and flushing (1,2,5).…”

mentioning

confidence: 99%

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Lentschener¹,

Gaujoux²,

Tesnière³

et al. 2011

European Journal of Endocrinology

121

141

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Adrenalectomy for pheochromocytoma is reported with a mortality close to zero in recent studies. The dogma of preoperative fluid and hypotensive drug administrations is widely applied in patients scheduled for pheochromocytoma removal and is assumed to have a beneficial effect on operative outcomes. This paradigm is only based on historical studies of non-standardized practices and criteria for efficacy, with no control group. Pre-and intraoperative hypovolemia have never been demonstrated in patients scheduled for pheochromocytoma removal. Recent improvements in outcome of patients undergoing adrenalectomy for pheochromocytoma could also be the result of improvement in surgical techniques and refinement in anesthetic practices. Whether better knowledge of the disease, efficiency of available intravenous short-acting vasoactive drugs, and careful intraoperative handling of the tumor make it possible to omit preoperative preparation in most patients scheduled for pheochromocytoma removal is presently questionable. We reviewed available literature in this respect.

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“…There also are several case reports of severe hypoglycaemia occurring postoperatively in patients undergoing adrenalectomy for phaeochromocytoma, and it is possible that infarction of such a tumour may have the same effect. 7 However, there was only a small area of central haemorrhage in this tumour post-mortem, making this an unlikely contributory factor.…”

Section: Pm 252/06mentioning

confidence: 81%

Phaeochromocytoma crisis presenting with profound hypoglycaemia and subsequent hypertension

Frankton¹,

Baithun²,

Husain³

et al. 2009

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A patient was presented with four days of vomiting, abdominal pain and sweating. At presentation the Capillary Blood Glucose (CBG) was 1.7 mmol/L, the Blood Pressure (BP) was 182/102 mmHg, and the pulse 100 bpm. on examination, he was sweaty, pale and cold. The initial differential diagnosis was hypoglycaemia secondary to insulin abuse, hypoadrenalism or insulinoma, the transient hypertension being considered a consequence of sympathetic stimulation. He remained clinically well overnight with a CBG of 10-14 mmol/L following intravenous glucose. The next morning he complained of nausea and abdominal pain. The BP had risen to 203/127 mmHg when he was later reviewed, having been given 10mg intramuscular metoclopramide. Shortly afterwards, he developed acute pulmonary oedema and had become hypoglycaemic again; a phaeochromocytoma crisis was suspected. Treatment with α-adrenoceptor blockade with intravenous phenoxybenzamine was advised. However, the patient deteriorated and died in the Intensive Care Unit within two hours. Autopsy examination confirmed a phaeochromocytoma in the left adrenal, with haemorrhage within the head of pancreas, but no evidence of a pancreatic tumour.

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Prolonged hypoglycaemia following surgical removal of phaeochromocytoma

Cited by 16 publications

References 5 publications

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

Incidence and predictive factors of hypoglycemia after pheochromocytoma resection

Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal?

Phaeochromocytoma crisis presenting with profound hypoglycaemia and subsequent hypertension

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