Introduction: Postoperative outcomes of patients with normotensive pheochromocytomas are poorly documented. We aimed to evaluate the impact of preoperative hypertension on post-operative outcomes following adrenalectomy for pheochromocytoma.
Methods: An international retrospective study of patients undergoing adrenalectomy for pheochromocytoma in 46 centers between 2012-2022 was performed. Hypertensive and normotensive pheochromocytoma were defined respectively by the presence or absence of hypertension history before or at the time of pheochromocytoma diagnosis. To evaluate differences in postoperative outcomes between hypertensive and normotensive patients, propensity score matched (PSM) analysis was performed.
Results: Among 2,016 patients with pheochromocytoma, 1,034 (51.2%) had preoperative hypertension and 982 (49.8%) were normotensive. Hypertensive patients were 4.5 years older (p<0.001), had higher prevalence of type 2 diabetes (p<0.001), had a higher median Charlson Comorbidity Index (2.0 vs. 1.0; p<0.001) and had an ASA III-IV more frequently (41% vs. 19.9%, p<0.001) than normotensive patients. Non-adjusted analysis demonstrated that hypertensive patients had longer operative time (115.0 vs. 103.5 minutes; p=0.026), higher rate of vasopressors at skin closure (19.7% vs 15.4%; p=0.013), more perioperative blood transfusions (7.7% vs. 5.0%; p=0.016) and increased complication rate (21.6% vs. 17.7%; p=0.029). However, after 1:1 PSM, we found that readmission, complications, and serious complications were similar between cohorts.
Conclusions: Patients with hypertensive pheochromocytomas have a higher risk of postoperative complications than normotensive cases due to the association of hypertension with a higher burden of comorbidities and older age. However, hypertension is not an independent risk factor of postoperative complications after pheochromocytoma surgery.
Keywords: Clavin-Dindo; hypertensive; normotensive; pheochromocytoma; surgical outcomes.
© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society.