Clinical Analysis of Pheochromocytoma and Abdominal Paragangliomas / 대한내분비외과학회지

PURPOSE: We compared clinical characteristics between pheochromocytoma and abdominal paragangliomas and identified predictive factors of malignancy. METHODS: Between November, 1995 and January, 2011, we retrospectively reviewed the medical records of 145 patients with pheochromocytoma and abdominal paraganglioma at Samsung Medical Center. We compared two tumors (pheochromocytoma vs abdominal paraganglioma) about a potential of hypersecretion of cathecholamines and identified predictive factors of malignancy by analysis of clinical characteristics, biochemical markers, tumor features. Their postoperative results were also evaluated. RESULTS: This study included 103 (71%) pheochromocytomas and 42 (29%) abdominal paragangliomas. Eighty-six percent were benign and 14% were malignant. Patients with paraganglioma were more predominantly men and exhibited a higher malignancy rate (P<0.01) than pheochromocytoma patients. Most (95%) pheochromocytoma was hyperfunctional, but abdominal paraganglioma were hyperfunctional in 74%. There were no significant differences in biochemical markers between the pheochromocytoma and paraganglioma groupd. When compared with benign tumor, malignant tumors were significantly related with higher mean PASS (P<0.01) and higher 24-hour urinary VMA (P=0.02), but not with larger tumor size. CONCLUSION: It is not easy to distinguish malignant from benign tumors by clinical characteristics and pathologic features in the management of pheochromocytoma and paraganglioma. We should keep in mind that abdominal paraganglioma can be also hyperfunctional in many pheochromocytoma patients and has a higher risk of malignancy.

Postoperative Outcomes in Patients Undergoing Adrenalectomy for Primary Aldosteronism / 대한내분비외과학회지

PURPOSE: Primary aldosteronism (PA) is characterized by hypertension (HTN), hypokalemia, suppressed plasma renin activity, and inappropriate aldosterone secretion. The purpose of this study was to analyze postoperative results on blood pressure (BP), and to determine the factors associated with resolution of HTN after adrenalectomy for PA. METHODS: One hundred eight patients (66 females and 42 males) with a mean age of 46 years underwent adrenalectomy for PA between January 1, 1996 and September 30, 2009. Their clinical characteristics and biochemical parameters were reviewed retrospectively. RESULTS: All patients had HTN preoperatively and 20 patients (18.1%) had uncontrolled HTN. Hypokalemia was evident in 89.1% of patients, cardiovascular events in 4.5% and cerebrovascular events in 8.2%. There was a significant decrease in both systolic BP and diastolic BP postoperatively, as compared with that before operation. Median systolic BP decreased from 150 mmHg to 125 mmHg at the last follow-up (P<0.01), and median diastolic BP decreased from 93.5 mmHg to 81.5 mmHg (P<0.01). Sixty two (57.4%) patients were cured of HTN and did not require any hypertensive agent, and 38 (35.1%) patients had an improvement in BP control, whereas 9 (8.3%) patients had no change in BP. Univariate analysis showed that duration of HTN and more than two HTN treatment agents were independent factors predicting sustained hypertension after surgery. CONCLUSION: The duration of HTN and the severity of HTN are factors influencing persistence of HTN after operation for a PA.