Related Analysis Of Various Factors Of Adrenal And Extra-adrenal Pheochromocytoma In Hospital And Follows-up

BACKGROUNDPheochromocytoma is the tumor origin from the chromaffin cells of of neural crest, it can synthesize, store and release large amounts of catecholamines, caused a series of clinical symptoms, such as persistent or paroxysmal hypertension, headache, hyperhidrosis, palpitation. The incidence of pheochromocytoma is two parts per million, there are no significant differences in the incidence between men and women, it can occur at any age, were mainly seen in young and middle-aged patients. Pheochromocytoma is a rare cause of hypertension, approximately 0.1% to 0.2% percent. Accounted for about 10% of malignant pheochromocytoma, it has poorer prognosis and high recurrent rates. It will be defined as an tumor origin from chromaffin cell with released catecholamines in adrenal pheochromocytoma by WHO in 2004. Malignant pheochromocytoma is that metastatic lesion occurred in non-chromaffin tissue, including the liver, lymph nodes, lungs, and bone metastases. Currently, using the HPLC-ED method to determine MNs is as preferred biochemical diagnosis of pheochromocytoma, thus CT, MRI and PET can also be used for location diagnosis of pheochromocytoma, but 131I-MIBG is a more specific positon diagnosis method.OBJECTIVEIn this study, we made a clinical retrospective analysis of 103 patients with pheochromocytoma, explored the correlation analysis of factors in pheochromocytoma patients in hospital and follows-up, then progressed early diagnosis and early treatment to prevent the recurrence and mortality reduction with pheochromocytoma.PATIENTS AND METHODS1. Subjects: 103 cases of pheochromocytoma in hospital from February 1999 to December 2009,there are confirmed by imaging and pathological examination. There are fifty-four male cases and forty-nine female cases, age from sixteen to seventy-five years old, the average age was about fourty-seven years old, the average day in hospital is about twenty days.2. Research methods:①case collection: record related laboratory tests of pheochromocytoma patients after admission, such as twenty-four hour plasma catecholamines in urine, plasma metanephrine (MN) and norepinephrine (NMN), ACTH, aldosterone, blood cortisol, blood Renin, angiotensinⅡ, fasting blood glucose and blood pressure levels. And record ages, admission time, hospital day and so on.②Telephone follow-up: the contents of follow-up include recurrence rate of pheochromocytoma and the level of blood glucose and blood pressure.③Data arrangement and analysis: analyze the factors about age, sex, E, NE, DA, MN, NMN, blood glucose and systolic pressure, diastolic pressure etc. and the analysis of relationship between factors and recurrence, hospital days and death, understand the occurrence, development and prognosis of all pheochromocytoma patients comprehensively.3. Statistical analysis: measurement data expressed as mean±Standard deviation,count data expressed as a percentage, apply SPSS13.0 software for statistical analysis of all datas, think that P<0.05 represent the results have statistical significance.RESULTS1. In selected cases, there are fifty-two cases of hypertension symptoms (about fifty percent) ,fifty-one cases of non-hypertension(about fifty percent), which have thirty-seven cases of paroxysmal hypertension, fifteen cases of persistent hypertension. Fifty-seven cases with triple syndrome or one of these symptoms; there are also twenty-four cases of pheochromocytoma (about twenty-four percent) without typical symptoms, six cases of family history of hypertension (about six percent).2. All hospitalized patients make related qualitative laboratory examinations, such as twenty-four hour urinary adrenaline, norepinephrine,dopamine, fourty-six rised in fifty-eight cases, two cases make twenty-four hour urinary free adrenaline, norepinephrine,dopamine, are rising; ten cases check plasma norepinephrine (MN) and norepinephrine (NMN), seven cases of MN and ten cases of NMN increased, Thirty-five cases examine plasma ACTH, five cases elevated, fourty-one rised in seventy-six cases about blood aldosterone, fourteen of seventy-four cases rised on plasma cortisol, twenty-seven of fifty-seven cases elevated about plasma renin, and sixty-four cases of angiotensinⅡ, twenty-nine rised, two cases check twenty-four hour urinary VMA, only one increased.3. All pheochromocytoma patients checked by B ultrasound, CT, MRI and other image examination, the results show that ninty-six cases progressed positioning examination, eighty-nine were Positioning accuracy, the positive rate was 93%, ninty-nine cases checked by CT, positive rate was 100%; twenty-one cases examined by MRI, all cases were positioning accuracy, positive rate was 100%, only one case checked by PET-CT, the result showed positive.4. All patients examined blood glucose testing in hospital, there were fourty-one cases with preoperative fasting hyperglycemia in one hundred and three cases of patients, the average blood glucose value was 7.8mmol/L; all patients'fasting blood glucose in the patients who have elevated urinary CA, postoperatively blood glucose decreased significantly in fifteen patients, blood glucose of twenty-one cases returned to normal, the postoperative average blood glucose was 6.7mmol/L. Seven cases of preoperative fasting hyperglycemia patients have previous history of diabetes, fasting blood glucose of five cases was lower than before postoperatively, one case was return to normal. So fasting blood glucose level is related to the occurrence and development of pheochromocytoma.5. All patients for operation are progressed routine preoperative preparation, such as taking alpha receptor blocker phenoxybenzamine or selective alpha-1 receptor blocker terazosin tablets. In this study, ninty-six patients through abdominal or laparoscopic surgery to treat pheochromocytoma, in addition, four cases treated by CT-guided percutaneous ethanol injection under local anesthesia. Average diameter of tumor is 6.2cm, while separating tumor, about 50% appear blood pressure fluctuation significantly, postoperative blood pressure returned to normal in most patients, the blood pressure levels decreased in remaining patients than preoperative blood pressure.6. The number of follow-up is sixty-three cases in one hundred and three pheochromocytoma patients, loss to follow-up cases is forty, including four patients with malignant pheochromocytoma, the follow-up patients does not occur the situation of recurrence, reviewed by B ultrasound or CT are no exceptions. Blood glucose, blood pressure maintain normal, very few parts of hyperglycemic and hypertensive patients by oral drugs can make blood glucose, blood pressure be controlled at about 8mmol/L and 140/90mmHg.7. Five cases of extra-adrenal pheochromocytoma patients with CT location, mainly located at the lower margin of pancreas tail and below the pancreatic gland and behind,nearby abdominal aorta, the lower pole of the kidney, the lower margin of right liver. Using open abdominal surgery, the blood pressure levels all maintain normal postoperatively.8. Preoperatively four cases of pheochromocytoma treated by CT-guided percutaneous ethanol injection, taking phenoxybenzamine to control blood pressure, and beta receptor blockers to adjust heart rate, there was no obvious discomfort symptoms, postoperative blood pressure is lower than before, no relapse occurs. CONCLUSION1. About 76% of pheochromocytoma patients manifested symptoms such as hypertension, headache, palpitations, hyperhidrosis, about one-fourth were incidental tumors without typical symptoms. There are no obvious differences of incidence between men and women, high age was at middle age period. Fasting hyperglycemia is linked to the occurrence and development of pheochromocytoma after admission.2. The hospital days and death is positive to the age of onset with pheochromocytoma patients,the greater age of onset in patients with pheochromocytoma, their illness and prognosis was much worse. The sex, blood pressure, whether the initial onset and other factors may have little effect on the recurrence, hospital days, death of pheochromocytoma. But catecholamine and blood glucose levels rise together is the risk factors for the occurrence of pheochromocytoma.3. For pheochromocytoma patients with or without typical symptoms, with or without previous history of hypertension, diabetes, we are adopting qualitative location check for early diagnosis and early treatment, reducing the risk of recurrence of pheochromocytoma, shorten hospital days, reduce the death rate.