Endocrine Abstracts

The usual management at our centre for patients awaiting phaeochromocytoma surgery involves pre-operative titration of alpha blockade with frequent clinic visits for blood pressure (BP) and heart rate (HR) monitoring. The COVID-19 pandemic restricted our ability to consult with patients frequently. To reduce infection risk, we incorporated virtual BP monitoring using a Microsoft Excel template coupled with regular remote consultations. We present a clinical case highlighting our adaptation. A 69-year-old woman with hypertension was incidentally found to have a 3.1cm left adrenal mass following the localised resection of a left arm dermatofibrosarcoma. Investigations revealed plasma normetanephrines of 7367 pmol/l (0-1180). Her plasma metanephrines, 3-methoxytyramine and aldosterone-to-renin ratio were normal. She suppressed cortisol adequately following dexamethasone. Functional imaging confirmed a solitary phaeochromocytoma. Genetic testing did not reveal abnormalities. The patient recorded home lying and standing BP using our virtual template and shared it weekly via secure email. Dose titration and side-effect assessment were done using remote telephone consultations. The patient later underwent an uncomplicated left-sided robot-assisted laparoscopic adrenalectomy with no significant post-operative hypotension and was able to stop antihypertensive therapy. Following the successful management of our patient’s case, we expanded the use of our template to four further patients with phaeochromocytomas: 2 have been treated successfully surgically (uncomplicated) and 2 are awaiting surgery. All patients provided positive feedback with specific comments including ease of use and improvements in engagement, confidence and autonomy in relation to their condition. We subsequently updated our management pathway to incorporate enhanced home BP/HR monitoring and recording with the aim of reducing the number of face-to-face visits. We demonstrate that using a virtual monitoring pathway is feasible and convenient in the pre-operative management of patients with phaeochromocytoma. Our pathway may be incorporated into the standard pre-operative management of patients thereby potentially increasing efficiency and reducing risk.