RF33 | PSUN03 Rates of Pheochromocytoma/Paraganglioma Screening in At-Risk Populations

Abstract

Background Hypertension is estimated to affect 1: 2 adults in the USA, and secondary hypertension accounts for up to 40% cases. Pheochromocytomas and paragangliomas (PPGL) are thought to be rare causes of hypertension, although their true prevalence might be underestimated. Less than half of patients with PPGL have prototypical symptoms. PPGL can lead to serious complications, including death, particularly if unrecognized. Expert guidelines recommend screening for secondary causes of hypertension in patients with resistant hypertension, patients with early-onset hypertension, and in those with hypertension and an adrenal mass. The rates of PPGL screening are unknown. Objective To evaluate the rates and patterns of PPGL screening among candidate patients. Methods We conducted a retrospective review of adult patients (age ≥ 18 years) with hypertension seen in a university-based outpatient setting between 01/01/2017 - 06/30/2020, and we included patients with: 1) resistant hypertension (uncontrolled hypertension while taking at least 3 antihypertensive agents OR taking ≥4 antihypertensive agents); 2) hypertension at age <35 years; 3) adrenal nodule(s). We excluded patients with renovascular hypertension, advanced chronic kidney disease (CKD stage ≥4), stage III and IV heart failure, adrenal insufficiency, and congenital adrenal hyperplasia. Results Of 203,535 patients with hypertension, 71,088 (35%) met at least one of the above criteria, and only 2013 (2.83%) were screened for PPGL. Overall, patients screened were younger (56.2 ± 17.4 vs. 63.9±17.1 years, p <0.001), more often women (54.1% vs. 44.2%, p=0.001), and non-smokers (54.6% vs. 47.5%, p<0.001) than those not screened. While most patients included in the study were white (80%), the proportion of black patients was larger among those screened (19.9% vs.13.3% of those not screened, p<0.001). Of the three indications for PPGL screening, the rates were highest in patients with hypertension and adrenal nodule(s) (51.7%), while patients with early onset hypertension and those with resistant hypertension were rarely screened (3.9% and 2.4%, respectively). Multivariable logistic regression with LASSO selection showed that the odds of PPGL screening were higher in black vs. white patients (1.35 [1.19-1.53]); those who never smoked (1.68 [1.41-2.00]); patients with stroke (1.34 [1.16-1.54]); dyslipidemia (1.41 [1.26-1.57]), CKD (1.40 [1.26-1.56); obstructive sleep apnea (1.96 [1.76-2.19]); and adrenal nodules (55.1 [44.53-68.17]). Conclusions Screening for PPGL is conducted in roughly half of patients with adrenal nodules and hypertension, but rarely in patients with resistant or early onset hypertension. Screening occurs more often in patients with complications known to be associated with PPGL, including cardiovascular accidents. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:12 p.m. - 1:17 p.m.