Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study

in European Journal of Endocrinology
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  • 1 Department of Endocrinology, Groningen, The Netherlands
  • | 2 Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  • | 3 Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
  • | 4 Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
  • | 5 Department of Surgical Oncology, Groningen, The Netherlands
  • | 6 Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  • | 7 Department of Internal Medicine Section Endocrinology, Amsterdam University Medical Centers location VUmc, Amsterdam, The Netherlands
  • | 8 Department of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
  • | 9 Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
  • | 10 Department of Internal Medicine, Medical Spectrum Twente, Enschede, The Netherlands
  • | 11 Department of Internal Medicine, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
  • | 12 Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands
  • | 13 Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands

Correspondence should be addressed to A M A Berends Email m.a.berends@umcg.nl
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Background

Despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection.

Methods

Study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as the occurrence of perioperative cardiovascular events.

Results

A total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 (0.41–0.63) nmol/L and 68.7 (27.9–150.4) ng/L, respectively. Neither MR-proADM nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 0.44, P =0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR: 5.46, P =0.013 and OR: 1.54, P =0.017, respectively).

Conclusions

plasma MR-proADM or NT-proBNP should not be considered as biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
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