Pheochromocytoma characteristics and behavior differ depending on method of discovery

Lucinda M. Gruber, Robert P. Hartman, Geoffrey B. Thompson, Travis J. McKenzie, Melanie L. Lyden, Benzon M. Dy, William F. Young, Irina Bancos

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Context: Modern pheochromocytomas (PHEOs) are often discovered by incidental finding on cross-sectional imaging or mutation-based genetic case detection testing. Little is known about how these PHEOs behave. Objective: To describe the characteristics and behavior of PHEOs discovered incidentally on imaging or through mutation-based genetic case detection testing. Design: Retrospective study. Setting: Referral center. Patients: Consecutive patients with pathology-confirmed PHEOs, treated from 2005 to 2016. Main Outcome Measure(s): Tumor size, plasma/urine fractionated metanephrines and catecholamines, and preoperative management. Results: Two hundred seventy-one patients (52% women, median age 52.0 years) presented with 296 PHEOs. Discovery method was most often incidental finding on cross-section imaging (61%) rather than PHEO-related symptoms (27%) or mutation-based case detection testing (12%). Patients with incidentally discovered PHEOs were older than symptomatic and mutation-based case detection testing patients (median age 56.6 vs 43 vs 35 years, P, 0.0001). Mutation-based case detection PHEOs were smaller than those discovered dueto symptoms (median size 29.0 vs 50.5 mm, P =0.0027). Patients with PHEOs discovered due to symptoms had the highest median concentration of 24-hour urinary metanephrines and total plasma metanephrines (P, 0.0001). These patients required a higher cumulative phenoxybenzamine dose than patients with incidental or case detection PHEO (median 450 vs 375 vs 270 mg, P = 0.029). Conclusions: PHEOs are primarily discovered due to incidental finding on cross-sectional imaging rather than PHEO-related symptoms. PHEOs discovered through mutation-based genetic case detection testing were smaller and required less α-adrenergic blockade preoperatively compared with PHEOs found due to symptoms, which supports routine case detection testing for patients genetically predisposed for PHEOs.

Original languageEnglish (US)
Pages (from-to)1386-1393
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number5
DOIs
StatePublished - Jan 1 2019

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    Gruber, L. M., Hartman, R. P., Thompson, G. B., McKenzie, T. J., Lyden, M. L., Dy, B. M., Young, W. F., & Bancos, I. (2019). Pheochromocytoma characteristics and behavior differ depending on method of discovery. Journal of Clinical Endocrinology and Metabolism, 104(5), 1386-1393. https://doi.org/10.1210/jc.2018-01707