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The clinical characteristics of patients with normotension in pheochromocytomas and paragangliomas

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Abstract

Purpose

The predominant symptom of pheochromocytomas and paragangliomas (PPGLs) is variable hypertension (HTN); however, not all patients with PPGLs develop HTN. Studies of the clinical characteristics of normotensive patients and which patients are more likely to develop HTN in PPGLs are rare. This study was performed to identify the clinical features to better understand this clinical entity.

Methods

All consecutive adult patients with PPGLs were retrospectively enrolled from January 2018 to June 2020. The clinical characteristics of the patients were investigated. Multivariate logistic regression analysis was used to identify risk factors and receiver operating characteristic curves were used to evaluate the diagnostic performance of the variables.

Results

There were 203 patients in the analysis, including 115 patients with normotension. Fewer patients with normotensive PPGLs had diabetes (p < 0.001) and clinical symptoms (p < 0.001). The 24-h urinary epinephrine (p = 0.002) and 24-h urinary norepinephrine (24hU-NE) concentrations (p < 0.001) were lower, and tumor diameter (p < 0.001) was smaller in patients with normotensive PPGLs. Multivariate logistic regression analysis showed that diabetes and 24hU-NE concentration were independent and negative risk factors for normotensive PPGLs. The area under the curve of 24hU-NE concentration and diabetes for predicting normotensive PPGLs was 0.788 and 0.634, respectively. Combining diabetes and 24hU-NE concentration into one model, the area under the curve of the model for predicting normotensive PPGLs was 0.817.

Conclusions

Normal blood pressure could not exclude PPGLs. Identifying the clinical characteristics of normotensive and hypertensive patients in PPGLs is helpful for risk stratification and individualized assessment and treatment.

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Acknowledgements

We are grateful to all the participants of this research.

Funding

This work was supported by the Science and Technology Innovation 2030 “New Generation Artificial Intelligence” Major Project (Ministry of Science and Technology) (2020AAA0109600), the CAMS Innovation Fund for Medical Sciences (CIFMS, 2022-I2M-C&T-A-010) and the National Key Research and Development Program of China (2016YFC1300100). The funding sources had no involvement in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the article for publication.

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Author notes

  1. These authors contributed equally: Lin Zhao, Ting Zhang

Authors and Affiliations

  1. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Lin Zhao, Xu Meng, Zenglei Zhang & Xianliang Zhou

  2. Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    Ting Zhang, Yecheng Liu & Huadong Zhu

  3. Department of Family Medicine and Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China

    Ting Zhang

  4. Department of Urology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    Hua Fan

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  1. Lin Zhao
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Contributions

L.Z., Y.L. and X.Z. conceptualized and designed the study. L.Z., T.Z. and X.M. provided analyzed and interpreted the data. L.Z., T.Z., H.F. and Z.Z. provided statistical support, including data collection and assembly. Y.L., X.Z. and H.Z. reviewed the framework and content of the discussion. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yecheng Liu or Xianliang Zhou.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Peking Union Medical College Hospital (approval number: JS-2898). Owing to the retrospective nature of the study and all data were anonymized before analysis, the requirement for informed consent in this study was waived.

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Zhao, L., Zhang, T., Meng, X. et al. The clinical characteristics of patients with normotension in pheochromocytomas and paragangliomas. Endocrine 80, 174–182 (2023). https://doi.org/10.1007/s12020-022-03293-4

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  • DOI: https://doi.org/10.1007/s12020-022-03293-4

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