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Multicenter Study
. 2025 Oct 16;110(11):e3719-e3729.
doi: 10.1210/clinem/dgaf154.

Postoperative Outcomes in Normotensive and Hypertensive Pheochromocytomas: An International Study

Marta Araujo-Castro  1   2 , Aura Herrera  3 , Yanbo Wang  4 , Zhicheng Wang  4 , Maciej Śledziński  5 , Andrzej Hellmann  5 , Marco Raffaelli  6 , Francesco Pennestrì  6 , Mark Sywak  7 , Alexander J Papachristos  7 , Fausto F Palazzo  8 , Tae-Yon Sung  9 , Byung-Chang Kim  9 , Yu-Mi Lee  9 , Fiona Eatock  10 , Hannah Anderson  10 , Maurizio Iacobone  11 , Albertas Daukša  12 , Ozer Makay  13 , Yigit Turk  14 , Hafize Basut Atalay  13 , Els J M Nieveen van Dijkum  15 , Anton F Engelsman  15 , Isabelle Holscher  15 , Gabriele Materazzi  16 , Leonardo Rossi  16 , Chiara Becucci  16 , Susannah L Shore  17 , Clare Fung  17 , Alison Waghorn  17 , Radu Mihai  18 , Sabapathy P Balasubramanian  19 , Arslan Pannu  19 , Shuichi Tatarano  20 , David Velázquez-Fernández  21 , Julie A Miller  22 , Hazel Serrao-Brown  7 , Yufei Chen  23 , Marco Stefano Demarchi  24 , Reza Djafarrian  24 , Helen Doran  25 , Kelvin Wang  25 , Michael J Stechman  26 , Helen Perry  26 , Johnathan Hubbard  27 , Cristina Lamas  28 , Philippa Mercer  29 , Janet MacPherson  30 , Supanut Lumbiganon  31 , María Calatayud  32 , Felicia Alexandra Hanzu  33 , Oscar Vidal  34 , Cesar Minguez Ojeda  35 , Theodosios Papavramidis  36 , Pablo Rodríguez de Vera Gómez  37 , Abdulaziz Aldrees  38 , Tariq Altwjry  38 , Nuria Valdés  39 , Cristina Álvarez-Escola  40 , Iñigo García Sanz  41 , Concepción Blanco Carrera  42 , Laura Manjón-Miguélez  43   44 , Paz De Miguel Novoa  45 , Mónica Recasens  46 , Rogelio García Centeno  47 , Cristina Robles Lázaro  48 , Klaas Van Den Heede  49 , Sam Van Slycke  49 , Theodora Michalopoulou  50 , Sebastian Aspinall  51 , Ross Melvin  51 , Joel Wen Liang Lau  52 , Wei Keat Cheah  52 , Man Hon Tang  52 , Han Boon Oh  52 , John Ayuk  53 , Kevin Verhoeff  54 , Robert P Sutcliffe  55 , Alessandro Parente  55   56
Affiliations
Multicenter Study

Postoperative Outcomes in Normotensive and Hypertensive Pheochromocytomas: An International Study

Marta Araujo-Castro et al. J Clin Endocrinol Metab. .

Abstract

Context: Postoperative outcomes of patients with normotensive pheochromocytomas are poorly documented.

Objective: We aimed to evaluate the impact of preoperative hypertension on postoperative outcomes following adrenalectomy for pheochromocytoma.

Methods: An international retrospective study of patients undergoing adrenalectomy for pheochromocytoma in 46 centers between 2012 and 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 2016 patients with pheochromocytoma, 1034 (51.2%) had preoperative hypertension and 982 (49.8%) were normotensive. Hypertensive patients were 4.5 years older (P < .001), had a higher prevalence of type 2 diabetes (P < .001), had a higher median Charlson Comorbidity Index (2.0 vs 1.0; P < .001), and had an American Society of Anesthesiologists score of III to IV more frequently (41% vs 19.9%; P < .001) than normotensive patients. Nonadjusted analysis demonstrated that hypertensive patients had longer operative time (115.0 vs 103.5 minutes; P = .026), higher rate of vasopressors at skin closure (19.7% vs 15.4%; P = .013), more perioperative blood transfusions (7.7% vs 5.0%; P = .016), and an increased complication rate (21.6% vs 17.7%; P = .029). However, after 1:1 PSM, we found that readmission, complications, and serious complications were similar between cohorts.

Conclusion: Patients with hypertensive pheochromocytomas have a higher risk of postoperative complications than normotensive patients 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.

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Figures

Figure 1.
Figure 1.
Study population.
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References

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