AUTHOR=Zhao Lin , Meng Xu , Mei QiMin , Fan Hua , Liu YeCheng , Zhou XianLiang , Zhu HuaDong , Zhang ShuYang 

TITLE=Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.877341

DOI=10.3389/fendo.2022.877341

ISSN=1664-2392

ABSTRACT=Background: Catecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations. Although there are reviews of reported cases, these reviews lack detailed data, which makes it impossible to perform an accurate analysis. In this study, we conducted a comprehensive analysis of cardiovascular complications (CCs), including PPGL-related myocardial injury, cardiogenic shock, and arrhythmias requiring antiarrhythmic therapy, in a large cohort of patients with PPGL.
Methods: We retrospectively analyzed the clinical data of consecutive patients with PPGL admitted between January 2018 and June 2020. The prevalence and the characteristics of patients with CCs were investigated. Moreover, comparisons were made between patients with and without CCs.
Results: Compared with the non-CC group, the percentage of men was significantly lower (14/41 vs.92/175, 34.1% vs. 52.6%, p = 0.034) and the proportion of patients with paroxysmal hypertension was significantly higher (13/41 vs.29/173, 31.7% vs.16.8%, p = 0.03) in the CC group. More patients showed excessive sweating (19/41 vs 64/175, 46.3% vs. 24.0%, p = 0.004) and PPGL crisis (7/41 vs. 10/175, 17.1% vs.5.7%, p=0.035) in the CC group. In terms of laboratory findings, higher white blood cell [7.36 (6.49, 20.23) vs. 5.95(×109/L) (5.1, 6.97), p＜0.001] and platelet (339.28±108.54 vs. 250.66±70.83(×109/L), p = 0.021) counts were more common in the CC group. There was also a higher prevalence of combination-producing PPGL in the CC group (13/24 vs.20/149, 54.2% vs.13.4%, p＜0.001). However, the tumor size, invasive behavior on histology, and hemorrhage or necrosis on histology did not differ between the two groups. Platelet count (odds ratio [OR]: 1.009; 95% confidence interval [CI] 1.001–1.016; p=0.023) and combination-secreting PPGL (OR: 5.009; 95% CI 1.365–18.38; p=0.015) are independent risk factors for CCs in patients with PPGL.
Conclusions: In patients with PPGL, even in the absence of CC signs and symptoms, a work up of cardiology should be strongly considered. Importantly, if a patient with PPGL has a higher platelet count and a combination-secreting PPGL, they are more likely to have CCs. Thus, a careful cardiac evaluation should be performed.