Analysis of clinical characteristics for hypertensive attack during pheochromocytoma and paraganglioma operation: a single center case report of 219 cases

Objective To analyze the clinical characteristics for hypertensive attack during operation and clinical experience of preoperative evaluation and preparation in patients with pheochromocytoma and paraganglioma(PHEO/PGL). Methods A total 219 PHEO/PGL cases from September 2016 to September 2018 were retrospectively reviewed. It included 99 males and 120 females, aged 13 to 76(average 47)years old.The mean diameter of tumor was 5.3 cm(1.5-18.0 cm).140 cases were unilateral PHEO, 6 cases were bilateral PHEO, 68 cases were PGL(jugular, mediaphragm, heart, retroperitoneum, pelvic and bladder) and 5 cases were PHEO combined with PGL. Preoperative highest systolic blood pressure (SBP)was 240 mmHg(1 mmHg=0.133 kPa) and highest diastolic blood pressure(DBP) was 160 mmHg. 20 cases were occult PHEO without hypertension. 217 cases accepted preoperative preparation of alpha-blocker [phenoxy-benzamine, dosage ranging from 5 mg Q12h to 40 mg Q8h, maximum dosage not exceeding 1 mg/(kg·24 h)]. 2 cases did not accept preoperative preparation. All cases accepted open or endoscope surgery. The patients were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. Results Histopathological results showed that all cases were PHEO or PGL, while 205 cases were benign, 14 cases were malignant. Hypertensive attack were recorded in 112 cases(51%). The diameter of tumors in the hypertensive attack group were larger than that in the non-hypertensive attack group[(6.70±2.95)cm vs.(3.95±1.70)cm, P=0.005]. There was no significant difference between the two groups among age[(51.0±10.8)years vs.(38.5±17.6)years, P=0.105], preoperative catecholamine level [norepinephrine (111.20±41.49)μg/24 h vs.(419.15±154.81)μg/24 h, P=0.075], time of use of alpha blockers[(53.0±7.5)d vs.(38.0±6.4)d, P=0.139], daily dosage of alpha blocker[(40.0±7.2)mg vs.(27.1±1.8)mg, P=0.111] and blood pressure at diagnosis[(173.75±26.69)mmHg vs.(155.0±20.75)mmHg, P=0.139]. Among 219 cases, 2 case had emergency hemostasis after operation, 1 case had catecholamine cardiomyopathy after operation for occult pheochromocytoma, and no perioperative death occurred. Conclusions Patients with large tumor tend to have hypertensive attack during operation so that should be better prepared. Key words: Pheochromocytoma; Paraganglioma; Alpha-blockade; Hypertension