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Surgical Resection of Pheochromocytomas and Paragangliomas is Associated with Lower Cholesterol Levels

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Abstract

Background

Catecholamine excess in patients with pheochromocytomas or paragangliomas (PPGLs) can lead to hypertension, diabetes and hyperlipidemia. The aim was to investigate the prevalence of hyperlipidemia and the effect of surgical resection.

Methods

One hundred and thirty-two patients with PPGLs underwent an operation at the National Institutes of Health from 2009 to 2016, of which 54 patients met the inclusion criteria. Clinical demographics, BMI, genetic mutations, tumor size, perioperative catecholamine levels and perioperative lipid panels were retrospectively reviewed. Spearman correlation between catecholamines and lipid levels was evaluated. Paired Wilcoxon and paired t test were used to analyze differences in pre- and postoperative lipid levels.

Results

Preoperatively, 51 patients (94.4%) had elevated catecholamines, thirteen (24.1%) had elevated total cholesterol (TC) (>200 mg/dL), nine (16.6%) had elevated LDL (>130 mg/dL) and ten (18.5%) had elevated triglycerides (>150 mg/dL). Serum and urinary metanephrine levels were positively associated with TC (r = 0.2792, p = 0.0372 and r = 0.4146, p = 0.0031, respectively) and LDL levels (r = 0.2977, p = 0.0259 and r = 0.4434, p = 0.0014, respectively). Mean TC decreased from 176.4 to 166.3 mg/dL (p = 0.0064) and mean HDL decreased from 56.7 to 53.2 mg/dL (p = 0.0253) after PPGL resection (median 3.1 months (range 1.3–50.2) between lipid panels). Most patients with elevated TC (76.9%) had improvement with mean TC decreasing from 225 to 200.2 mg/dL (p = 0.0230). Of patients with elevated LDL, 66.7% had improvement with mean LDL decreasing from 149 to 131.1 mg/dL (p = 0.0313).

Conclusions

The prevalence of hyperlipidemia in patients with PPGLs is 46%. Future prospective studies are needed to determine whether surgical resection improves TC and/or LDL levels.

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Funding

This research was supported by the Intramural Research Program of NIH.

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Authors and Affiliations

  1. Eunice Kennedy Shriver Surgery Oncology Program, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bldg 10, Rm 3W-5840, Bethesda, MD, 20892, USA

    Meghan L. Good, Parisa Malekzadeh, Samantha M. Ruff, Shreya Gupta, Amy Copeland & Naris Nilubol

  2. National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    Karel Pacak

  3. Stanford University, Palo Alto, CA, USA

    Electron Kebebew

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Dhaval Patel

Authors
  1. Meghan L. Good
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  2. Parisa Malekzadeh
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  3. Samantha M. Ruff
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  4. Shreya Gupta
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  5. Amy Copeland
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Contributions

DP and MLG conceptualized and designed the study. KP, NN, EK and DP identified, consented and treated the patients, including operative and perioperative care and acquisition of patient data. MLG, PM, SMR, SG, AC and DP assembled the patient data. MLG, PM, SMR and DP analyzed and interpreted the patient data. MLG, PM, SMR, SG, AC and DP contributed to writing the manuscript. All co-authors participated in revising the text and all co-authors reviewed and gave approval for the current form of the manuscript to be submitted.

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Correspondence to Meghan L. Good.

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The authors declare that they have no conflicts of interest.

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Good, M.L., Malekzadeh, P., Ruff, S.M. et al. Surgical Resection of Pheochromocytomas and Paragangliomas is Associated with Lower Cholesterol Levels. World J Surg 44, 552–560 (2020). https://doi.org/10.1007/s00268-019-05175-9

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  • DOI: https://doi.org/10.1007/s00268-019-05175-9

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