Objective: To discover the variables that may predict changes in blood pressure and blood sugar levels and to pinpoint the time frame during which such changes occur in patient with pheochromocytoma.
Material and Methods: Consecutive patients undergoing surgery for pheochromocytoma over a 20-month period were included in this ethics review board-approved, prospective cohort study. Blood pressure and sugar levels were serially monitored using a fixed protocol in the perioperative period and subsequently at 3 months after surgery. Changes were compared and assessed for the predictive factors.
Results: Fifty patients undergoing surgical procedures were included in the study of whom 32% developed hypotension and 10% developed hypoglycaemias after surgery. All hypotension episodes occurred within 6 hours of surgery. However, while 7 of 8 patients who developed hypoglycaemia manifest in the first 4 h after surgery, one occurred after 12 h. Occurrence of hypotension correlated with preoperative 24-h urinary vanillylmandelic acid levels (p=0.024). Out of 21 hypertensive patients, 15 had persistent hypertension at 3 months and this was associated with age (p=0.04) and diabetes mellitus (DM) at presentation.
Conclusion: 32% of patients receiving pheochromocytoma surgery experienced postoperative hypotension needing inotropic support. Patients who require greater dosages of alpha-blockers or those with higher 24-h urine VMA levels are more prone to experience this. This happens within the first six hours following surgery. Patients who are older or who have had DM for a long time are more likely to suffer chronic HTN following surgery.
Keywords: Pheochromocytoma, hypertension, hypoglycaemia, creatinine.
ABSTRACT
Objective: To discover the variables that may predict changes in blood pressure and blood sugar levels and to pinpoint the time frame during which such changes occur in patient with pheochromocytoma.
Material and Methods: Consecutive patients undergoing surgery for pheochromocytoma over a 20-month period were included in this ethics review board-approved, prospective cohort study. Blood pressure and sugar levels were serially monitored using a fixed protocol in the perioperative period and subsequently at 3 months after surgery. Changes were compared and assessed for the predictive factors.
Results: Fifty patients undergoing surgical procedures were included in the study of whom 32% developed hypotension and 10% developed hypoglycaemias after surgery. All hypotension episodes occurred within 6 hours of surgery. However, while 7 of 8 patients who developed hypoglycaemia manifest in the first 4 h after surgery, one occurred after 12 h. Occurrence of hypotension correlated with preoperative 24-h urinary vanillylmandelic acid levels (p=0.024). Out of 21 hypertensive patients, 15 had persistent hypertension at 3 months and this was associated with age (p=0.04) and diabetes mellitus (DM) at presentation.
Conclusion: 32% of patients receiving pheochromocytoma surgery experienced postoperative hypotension needing inotropic support. Patients who require greater dosages of alpha-blockers or those with higher 24-h urine VMA levels are more prone to experience this. This happens within the first six hours following surgery. Patients who are older or who have had DM for a long time are more likely to suffer chronic HTN following surgery.
Keywords: Pheochromocytoma, hypertension, hypoglycaemia, creatinine.