Endocrine Abstracts

Phaeochromocytoma is a rare neuroendocrine tumour. Incidence has been quoted at two to eight cases per million people. This study reviews all cases of surgically resected phaeochromocytoma in a large tertiary referral centre since 1996 with particular focus on preoperative care. 22 patients were diagnosed with Phaeochromocytoma with average age at diagnosis of 47 years. 13.6% (n=3) of patients had malignant phaeochromocytoma. Two patients had confirmed neurofibromatosis Type 1. The remaining cases were deemed sporadic and are awaiting genetic analysis. In terms of pre-operative optimisation, medical treatment involves alpha blockade initially +/− beta blockade if tachycardic. It took 9.7±8.2 days on average to obtain adequate alpha blockade. The mean dose of phenoxybenzamine used was 88.1±74.1 mg. The mean preoperative blood pressure on the day of surgery was 122/71±19/12 mm/Hg. The average postoperative blood pressure which was measured in recovery was 109/63±15/10 mm/Hg. The mean heartrate pre-operatively was 74±16 bpm corresponding with a postoperative value of 75±14 bpm. Of the 22 patients that underwent surgical resection, 81.8% of patients (n=18) required ITU/HDU care post-op with an average length of stay of 3.1±1.6 days. 50% (n=11) required inotropic support post-op for an average of 1.9±1.1 days. In terms of immediate post-op complications, hypotension was the most common. One patient (known catecholamine induced cardiomyopathy) developed a cardiac arrest during anaesthesic induction. There was one case of post op hypertension requiring nitrate infusion. Mortality related to surgery was nil. One patient has died secondary to complications of metastatic phaeochromocytoma, the other patient died of an unrelated condition. In the 22 cases described, each presented a unique set of management challenges. This report showed that once diagnosed, intensive medical stabilisation is required to prevent adverse surgical outcomes.