Rates of Pheochromocytoma/Paraganglioma Screening in At-Risk Populations

Abstract

Background Pheochromocytomas and paragangliomas (PPGL) are rare causes of secondary hypertension, but when unrecognized, they can lead to serious complications. Data regarding PPGL screening are lacking. Objective To assess the rates and patterns of PPGL screening among eligible patients. Subjects and Study Design We conducted a retrospective review of adults with hypertension seen in outpatient clinics of a large academic center between 01/01/2017 - 06/30/2020. We included patients with treatment-resistant hypertension, hypertension at age <35 years, and/or adrenal mass(es). Results Of 203,535 patients with hypertension identified, 71,088 (35%) met ≥1 inclusion criterion(a), and 2,013 (2.83%) were screened for PPGL. Patients screened were younger (56.2 ± 17.4 vs. 64.0 ± 17.1 years), more often women (54.1% vs. 44.2%), and never-smokers (54.6% vs. 47.5%, p < 0.001 for all). The rate of screening was highest in patients with hypertension and adrenal mass(es) (51.7%, vs. 3.9% in patients with early-onset hypertension, and 2.4% in those with treatment-resistant hypertension). Multivariable logistic regression showed higher odds of PPGL screening in women (OR [95% confidence interval, CI]: 1.48 [1.34 - 1.63]); black vs. white patients (1.35 [1.19-1.53]); patients with adrenal mass(es) (55.1 [44.53-68.15]), stroke (1.34 [1.16-1.54]), dyslipidemia (1.41 [1.26-1.58]), chronic kidney disease (1.40 [1.26-1.56]), and obstructive sleep apnea (1.96 [1.76-2.19]). Conclusions PPGL screening is pursued in roughly half of patients with adrenal nodules and hypertension, but rarely in patients with treatment-resistant or early-onset hypertension. Like for other forms of secondary hypertension, PPGL screening occurs more often after serious complications develop.