Surgery · 2026
Catecholamine-induced metabolic dysfunction and its reversal postsurgery in pheochromocytoma-paraganglioma patients: Insights from the "PheoMet" study.
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Wanchoo Mithlesh, Dariya Samprati, Hoysal Dileep R, Dabadghao Preeti, Mohindra Namita, L Raghavendra, Shukla Manoj, Srivastava Meera, Mayilvaganan Sabaretnam, Chand Gyan, Mishra Anjali, Agarwal Gaurav
Аннотация
BACKGROUND: Catecholamine excess in pheochromocytoma-paraganglioma is believed to result in numerous metabolic implications leading to insulin resistance and glucose intolerance.
METHODS: PheoMet was a prospective cohort study including 40 pheochromocytoma-paraganglioma patients and 20 age- and sex-matched controls with nonfunctioning adrenal tumors. Patients with comorbidities affecting metabolism were excluded. Metabolic evaluation comprised oral glucose tolerance testing with serial glucose, insulin, and C-peptide measurements preoperatively, early postoperatively (1-2 weeks), and at 6-month follow-up. Derived indices included homeostatic model assessment of insulin resistance, homeostatic model assessment of β-cell function, insulinogenic index, and disposition index. Lipid profile and hemoglobin A1c were also analyzed.
RESULTS: Patients and controls were age and sex matched. Study group patients had higher baseline systolic blood pressure and 24-hour urinary metanephrines and normetanephrines compared with controls; these normalized following surgery. Pheochromocytoma-paraganglioma patients demonstrated higher fasting glucose and postprandial glucose at 30, 60, 90, and 120 minutes, which declined significantly postsurgery across all postoperative time points (P = .001). Hemoglobin A1c showed a progressive decline from 6.18% ± 0.89 preoperatively to 5.51% ± 0.51 at 6 months. Insulin and C-peptide levels did not change significantly over time. Homeostatic model assessment of insulin resistance did not show any significant changes, whereas disposition index increased significantly from 0.57 (0.20-1.44) to 0.86 (0.56-1.67) (P = .02). Lipid profile did not exhibit any statistically significant longitudinal changes.
CONCLUSION: Pheochromocytoma-paraganglioma causes reversible catecholamine-mediated metabolic dysfunction. Curative surgery results in early and sustained improvement in glucose homeostasis. These results suggest the utility of comprehensive metabolic assessment in pheochromocytoma-paraganglioma patients.
METHODS: PheoMet was a prospective cohort study including 40 pheochromocytoma-paraganglioma patients and 20 age- and sex-matched controls with nonfunctioning adrenal tumors. Patients with comorbidities affecting metabolism were excluded. Metabolic evaluation comprised oral glucose tolerance testing with serial glucose, insulin, and C-peptide measurements preoperatively, early postoperatively (1-2 weeks), and at 6-month follow-up. Derived indices included homeostatic model assessment of insulin resistance, homeostatic model assessment of β-cell function, insulinogenic index, and disposition index. Lipid profile and hemoglobin A1c were also analyzed.
RESULTS: Patients and controls were age and sex matched. Study group patients had higher baseline systolic blood pressure and 24-hour urinary metanephrines and normetanephrines compared with controls; these normalized following surgery. Pheochromocytoma-paraganglioma patients demonstrated higher fasting glucose and postprandial glucose at 30, 60, 90, and 120 minutes, which declined significantly postsurgery across all postoperative time points (P = .001). Hemoglobin A1c showed a progressive decline from 6.18% ± 0.89 preoperatively to 5.51% ± 0.51 at 6 months. Insulin and C-peptide levels did not change significantly over time. Homeostatic model assessment of insulin resistance did not show any significant changes, whereas disposition index increased significantly from 0.57 (0.20-1.44) to 0.86 (0.56-1.67) (P = .02). Lipid profile did not exhibit any statistically significant longitudinal changes.
CONCLUSION: Pheochromocytoma-paraganglioma causes reversible catecholamine-mediated metabolic dysfunction. Curative surgery results in early and sustained improvement in glucose homeostasis. These results suggest the utility of comprehensive metabolic assessment in pheochromocytoma-paraganglioma patients.