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Background: During resections of phaeochromocytoma release of catecholamines can lead to excessive hypertension and arrhythmia. Therefore, these procedures can be stressful to surgeons and anaesthetists. It is completely unknown, how the excessive catecholamine concentrations in phaeochromocytoma patients relate to catecholamine concentrations of physiological stress of physicians and control patients undergoing adrenalectomy because of hormone inactive tumours. We measured catecholamine concentrations, heart rate and blood pressure in patients with phaeochromocytoma, incidentaloma, a surgeon and an anaesthetist.
Methods: After approval of the local ethics committee, we measured metanephrine and normetanephrine plasma concentrations in 8 patients with phaeochromocytoma, 6 control patients with incidentaloma, one surgeon and one anaesthetist at rest, after incision, after 20 and 40 minutes of surgery, and in recovery. Moreover, blood pressure and heart rate were obtained.
Results: Intraoperatively significant increases of blood pressure, metanephrine and normetanephrine were found in patients and surgeon. Significant increase of normetanephrine was also found in control patients. But catecholamine concentrations in patients with phaeochromocytoma were 18 to 42 times higher than in control patients and physicians. Heart rate analysis showed no significant results.
Conclusion: During phaeochromocytoma resections significant increases in catecholamine concentration and blood pressure can be found in patients and physicians. The excessive increase of catecholamine concentrations in phaeochromocytoma patients, was not always reflected by a corresponding blood pressure increase. Interestingly, although catecholamine concentrations in phaeochromocytoma patients almost normalize directly after surgery, their blood pressure remains stable without the need for pharmacological support.
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2. Neumann HP Young WF, Eng C. Pheochromocytoma and paraganglioma. N Engl J Med. 2019; 381: 552-65
3. Neumann HP, Young WF, Krauss T, Bayley JP, Schiavi F, Opocher G, et al.. 65 years of the double helix: Genetics informs precision practice in the diagnosis and management of pheochromocytoma. Endocr Relat Cancer. 2018; 25: T201-T219
4. Thompson JE, Arrowod JG. Pheochromocytoma: surgical and anesthetic management. Anesthesiology. 1954; 15(6): 658–665
5. Ross EJ, Prichard BN, Kaufman L, Robertson AI, Harries BJ. Preoperative and operative management of patients with pheochromocytoma. Br Med J. 1967; 1(5534), 191–198
6. Toniato A, Boschin IM, Opocher G, Guolo A, Pelizzo M, Mantero F. Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment? Surgery. 2007; 141(6): 723–727
7. Kercher KW, Novitsky YW, Park A, Matthews BD, Litwin DE, Heniford BT. Laparoscopic curative resection of pheochromocytomas. Ann Surg. 2005; 241(6): 919–926
8. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al.. Endocrine Society. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99(6): 1915-1942
9. Plouin PF, Gimenez-Roqueplo AP. Pheochromocytomas and secreting paragangliomas. Orphanet J Rare Dis. 2006; 1: 49
10. Groeben, H., Walz, M. K., Nottebaum, B. J., Alesina, P. F., Greenwald, A., Schumann, R, et al.. International multicentre review of perioperative management and outcome for catecholamine-producing tumours. Br J Surg 2020; 107(2): 170-178
11. Zelinka T, Pacák K, Widimský J Jr. Characteristics of blood pressure in pheochromocytoma. Ann N Y Acad Sci. 2006; 1073: 86-93
12. Bravo EL, Tarazi RC, Gifford RW, Stewart BH. Circulating and urinary catecholamines in pheochromocytoma. Diagnostic and pathophysiologic implications. N Engl J Med. 1979; 301(13): 682-686
13. Dahaba AA, Prax N, Gaube W, Gries M, Rehak PH, Metzler H. Haemodynamic and catecholamine stress responses to the Laryngeal Tube-Suction Airway and the Proseal Laryngeal Mask Airway. Anaesthesia. 2006; 61(4): 330-334
14. Spiss CK, Maze M. [Adrenoreceptors]. Anaesthesist. 1985; 34(1): 1-10
15. Bravo E, Fouad-Tarazi F, Rossi G, Imamura M, Lin WW, Madkour MA, et al.. A reevaluation of the hemodynamics of pheochromocytoma. Hypertension. 1990; 15(2): 128-131