Endocrine Abstracts

Introduction: Pheochromocytomas and paraganglioma are neuroendocrine tumors that arise from the chromaffin cells of the adrenal medulla or originate from the autonomic nerve ganglia. Hypertension in patients with PPGL is the most frequent symptom and can be responsible of lethal cardiovascular complications. The aim of our work is to describe the clinical characteristics of hypertension in PPGL, the treatment and the outcomes after surgical treatment.

Materials and methods: Our study is retrospective descriptive, involving 34 patients (29 patients with pheochromocytoma and 5 patients with functional paraganglioma) followed in our Endocrinology-Diabetology and Nutrition Department of Mohammed VI University Hospital Center in Oujda, Morrocco.

Results: The mean age of our patients was 47±17.9 years (15-81) with a sex ratio H/F of 0.4. History of hypertension was present in 58.8% of cases of which (55%) had uncontrolled treated hypertension, and (45%) had well controlled hypertension under antihypertensive medication. Hypertension was diagnosed at the same time as the tumor in 14.3% of cases. Half of our patients (47%) had permanent hypertension, 11.7% had paroxysmal hypertension and 11.7% experienced orthostatic hypertension. 24-h urinary metanephrine level was elevated in 76% of the cases, and 24 h urinary normetanephrine level was elevated in 84% of the cases. Imaging revealed unilateral abdominal PPGL in 73% of cases, bilateral pheochromocytoma in 11.7% of cases and cervical PGL in 6% of cases. The mean size of the tumor was 51.4 mm ± 29.4. Before surgery, all of our hypertensive patients received α1blockers preparation 15 days before surgery. Peroperatively, only 12% of patients presented hypertensive peaks without further complications. Good blood pressure control was achieved postoperatively and antihypertensive medication was reduced in all of our hypertensive patients with good clinical and biological outcomes.

Discussion–Conclusion: Although rare, PPGL can be dangerous due to the excess of catecholalmines and cardiovascular complications. Treatment of hypertension before, during and after the removal of the tumor is mandatory to avoid complications. The preoperative management of hypertension usually includes treatment with α1blockers at least 10 to 14 days before surgery, with the addition of beta blockers when necessary. Surgical removal of functional PPGL is the main treatment.

PPGL : Pheochromocytoma and paraganglioma