E.A. Todd1, M.R. Guido1, C. Saghira2, A. Cioci3, J.I. Lew2,3, T.M. Vaghaiwalla2,3 1University Of Miami, Leonard M. Miller School Of Medicine, Miami, FL, USA 2University Of Miami, DeWitt Daughtry Department Of Surgery, Miami, FL, USA 3University Of Miami, Division Of Endocrine Surgery, DeWitt Daughtry Department Of Surgery, Miami, FL, USA
Introduction:
Pheochromocytomas are rare neuroendocrine tumors of the adrenal gland with up to 40% of cases due to germline mutations. Catecholamine-induced signs and symptoms of pheochomocytomas can vary based on their biochemical phenotype, and early recognition leads to timely diagnosis and treatment. This study examines the preoperative clinical findings and surgical outcomes for patients treated for pheochromocytoma at a single, high-volume instiution.
Methods:
A retrospective review of prospectively collected data of 225 patients who underwent adrenalectomy from 2009 to 2022 at a tertiary care institution was performed. Patients were included in the study if they were referred with a diagnosis of pheochromocytoma preoperatively. Patients were excluded if they were <18 years of age and if they had an adrenal tumor other than pheochromocytoma. Patient demographics, medical histories, preoperative factors, surgical outcomes and final pathology results were examined.
Results:
Of 225 adrenalectomy patients, 70 patients with pheochromocytoma met the inclusion criteria and were included in the study. The majority of patients were women (60%, n=42) with a mean age of 50 years (SD + 15 years). Preoperatively, patients endorsed signs and symptoms including palpitations (37%, n=26), headaches (29%, n=20), diaphoresis (23%, n=16), hypertention (87%, n=61), and a combination of symptoms (56%, n=39). 65.7% (n=46) of patients reported taking anti-hypertensive medications, with 29% (n=20) taking 1 medication, 16% (n=11) taking 2, and 21% (n=15) taking >3 medications. A family history of pheochromocytoma and/or inherited tumor syndrome was endorsed for 7% (n=5), denied in 79% (n=55), and unknown for 14% (n=10) of patients. Genetic testing and/or genetic counseling was performed by referring physicians prior to the surgical visit for 7% (n=5) of patients. All patients had prior cross-sectional imaging with CT or MRI. Mean tumor size was 4.9cm (SD=+5.5cm). The majority of patients (96%, n=67) had a biochemical work up (serum and/or urinary metanephrines or catecholamines) completed prior to the surgical visit. The majority of patients underwent laparoscopic adrenalectomy (80%, n=56) compared to open adrenalectomy (20%, n=14). 3 patients received intraperative blood transfusions. There were no mortalities at 30 days for the entire cohort.
Conclusion:
The majority of pheochromocytoma patients referred for surgical evaluation had a history of classic signs and symptoms, completed a biochemical work up, had prior cross-sectional imaging, and were taking at least one anti-hypertensive. The majority of patients underwent minimally invasive adrenalectomy and excellent surgical outcomes were observed overall. More than 90% were referred without genetic testing and proceeded to surgery. These findings identify a potential role for surgeons to coordinate testing post-operatively, particularly if a multidisciplinary team is not accessible.