Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas

J Hypertens. 2024 Feb 1;42(2):252-259. doi: 10.1097/HJH.0000000000003596. Epub 2023 Oct 10.

Abstract

Purpose: To identify presurgical and surgical risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas (PGLs) (PPGLs).

Methods: Retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. Intraoperative hypertensive crisis was defined as systolic blood pressure (SBP) greater than 200 mmHg lasting more than 1 min and postoperative hypertensive crisis as SBP greater than 180 mmHg or diastolic blood pressure (DBP) greater than 110 mmHg.

Results: A total of 296 surgeries were included. Alpha presurgical blockade was employed in 93.2% of the cases and beta-adrenergic in 53.4%. Hypertensive crisis occurred in 20.3% ( n = 60) of the surgeries: intraoperative crisis in 56 and postoperative crisis in 6 cases (2 cases had both types of crises). We identified as risk factors of intraoperative hypertensive crisis, absence of presurgical glucocorticoid therapy (odds ratio [OR] 3.48; 95% confidence interval [CI] 1.19-10.12) higher presurgical SBP (OR 1.22 per each 10 mmHg, 95% CI 1.03-1.45), a larger tumor size (OR 1.09 per each 10 mm, 95% CI 1.00-1.19) and absence of oral sodium repletion (OR 2.59, 95% CI 1.25-5.35). Patients with hypertensive crisis had a higher rate of intraoperative bleeding ( P < 0.001), of intraoperative hemodynamic instability ( P < 0.001) and of intraoperative hypotensive episodes ( P < 0.001) than those without hypertensive crisis.

Conclusion: Intraoperative hypertensive crisis occurs in up to 20% of the PPGL resections. Patients not pretreated with glucocorticoid therapy before surgery, with larger tumors and higher presurgical SBP and who do not receive oral sodium repletion have a higher risk for developing hypertensive crisis during and after PPGL surgery.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Gland Neoplasms* / complications
  • Adrenal Gland Neoplasms* / pathology
  • Adrenal Gland Neoplasms* / surgery
  • Blood Pressure / physiology
  • Cohort Studies
  • Glucocorticoids
  • Humans
  • Hypertension* / epidemiology
  • Hypertensive Crisis*
  • Paraganglioma* / complications
  • Paraganglioma* / surgery
  • Pheochromocytoma* / complications
  • Pheochromocytoma* / pathology
  • Pheochromocytoma* / surgery
  • Retrospective Studies
  • Risk Factors
  • Sodium

Substances

  • Glucocorticoids
  • Sodium