Exp Clin Endocrinol Diabetes 2013; 121 - OP7_44
DOI: 10.1055/s-0033-1336653

Persistent Hypertension after successful resection of pheochromocytomas – results of a retrospective follow-up study

T Bergen 1, A Raida 1, M Fassnacht 1, F Weidemann 2, B Allolio 1, D Weismann 1
  • 1Medizinische Klinik I, Universität Würzburg, Endokrinologie, Würzburg, Germany
  • 2University Hospital of Wuerzburg, Würzburg, Germany

Aims: Secondary hypertension consists a well-defined group of diseases, with pheochromocytomas being one of these entities. Clinical experience suggests that complete removal of pheochromocytomas improves blood pressure (BP); however, this was never formally demonstrated.

Methods: We analysed resting BP, 24h-BP and metabolic parameters in 29 patients [11 females (mean-age 55.9 y), 18 males (mean-age 54.4 y)] with benign pheochromocytoma, who have had pheochromocytomas before. Diagnosis was based on symptoms, levels of plasma-metanephrines (M; 1177.53 ± 2379.64 ng/l) and normetanephrines (NM; 2155.75 ± 1739.89 ng/l), epinephrine (E; 108.38 ± 155.5 µg/d) and norepinephrine in 24h-urine (NE; 437.62 ± 520.11 µg/d) and tumors detected by computer tomography or MRI and up-take in MIBG-szintigraphy. The first plausible resting BP was taken from the charts. At follow-up, supine BP was measured after 20 minutes rest.

Results: Mean follow-up was 6.2 years. At follow-up, plasma metanephrine (M: 27.39 ± 14.53 ng/l and NM: 61.71 ± 30.82 ng/l) levels as well as urine catecholamine were in the normal range. No relapse was diagnosed. In contrast, we found no difference in mean systolic (144 ± 35 vs. 137 ± 18 mmHg) and diastolic (85+/-18 vs. 82 ± 10 mmHg) BP and no significant differences in the number of antihypertensive medication taken (1.14 ± 1 vs. 1.17 ± 1.3). However, in 24h-blood pressure analysis BP was overall well controlled with antihypertensive medication. Interestingly, while 4 patients were on insulin treatment initially, only 2 patients had insulin at follow-up and 7 patients were on oral antiglycemic drug treatment while only 4 had OADs at follow-up.

Conclusion: While the necessity of removal of pheochromocytomas is not questioned, our data show, that hypertension persists in a significant proportion of patients with an unchanged need for antihypertensive medication and the need for appropriate care and follow-up. However, no hypertensive crisis have been reported anymore.