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KMID : 1011820160570030184
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Investigative and Clinical Urology
2016 Volume.57 No. 3 p.184 ~ p.190
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Risk factors for hypertensive attack during pheochromocytoma resection
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Kwon Se-Yun
Lee Kyung-Seop
Lee Jun-Nyung
Ha Yun-Sok
Choi Seock-Hwan
Kim Hyun-Tae
Kim Tae-Hwan
Yoo Eun-Sang
Kwon Tae-Gyun
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Abstract
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Purpose: We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge.
Materials and Methods: Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects 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. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed.
Results: In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 μg/d.
Conclusions: In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma.
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KEYWORD
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Adrenalectomy, Catecholamine, Hypertension, Pheochromocytoma
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