Endocrine Abstracts

Aims: The aim of this project was to conduct a service review of phaeochromocytoma management and to benchmark local practice against national guidelines and recommendations defined in the ‘Getting It Right First Time’ (GIRFT) national report.

Methods: Electronic patient records were searched for patients referred to our centre, within our catchment area and from peripheral centres, with phaeochromocytoma between 2017 to February 2023. Data on their presentation, treatment, perioperative complications and follow-up were collected.

Results: Forty patients were identified during this period (average 6.5 patients/year). 21 (52.5%) of patients were referred from peripheral centres and 19 were internal referrals. Twenty-three (57.5%) presented incidentally, 11 (27.5%) with typical symptoms and 6 (15%) identified on surveillance of genetic syndromes. Twenty-five (65%) had tumour size between 2 and 6 cm and 5 (12.5%) >6 cm. Ninety-five percent were discussed at the adrenal multidisciplinary team meeting (MDT). 30 (75%) had adrenalectomy (80% laparoscopic, 20% open), 8 were managed conservatively, one received MIBG therapy for metastatic disease and one had no follow-up data. None of those managed conservatively were hospitalised for reasons related to their phaeochromocytoma during period covered by this review. Ninety-five percent of patients received preoperative medical preparation, with twice as many patients treated with doxazosin (57.5%) than phenoxybenzamine (27.5%). 57% received concomitant beta-blocker. Most achieved blood pressure (86%) and heart rate (93%) targets preoperatively. Sixty-seven percent of surgically treated patients, had uneventful intraoperative period, 33% experienced haemodynamic instability, mainly labile BP and intraoperative hypotension. 43% had a postoperative haemodynamic complication, mostly hypotension requiring inotrope support. 45% receiving phenoxybenzamine preoperatively experienced intraoperative complication versus 33% of those on doxazosin. 45% receiving phenoxybenzamine experienced postoperative complication versus 40% receiving doxazosin. 19 (63%) had a PASS score included in their histology report (PASS < 4 in 14 and PASS > 4 in 5 patients). 83% of patients had metanephrines performed 12 weeks postoperatively, whilst only 47% of patients had postoperative surveillance imaging at 3–6 months. 63% underwent annual metanephrines screening. 63% of surgically treated patients were offered genetic testing.

Discussion: Our review showed effective collaborative working of the adrenal MDT with peripheral centres. Doxazosin performed slightly better in terms of risk of peri/postoperative complications and was better tolerated. We identified developmental opportunities for perioperative and follow-up phaeochromocytoma pathways led by a specialist endocrine nurse with an independent prescriber qualification. We also identified a need for a standardised postoperative follow-up across the peripheral hospitals including consideration of genetic testing.