Association Between Clinical Factors and Postoperative Hypoglycemia in Pheochromocytoma and Paraganglioma: A Retrospective Cohort Study.

OBJECTIVES

This study aimed to investigate the correlation between clinical factors and postoperative hypoglycemia in pheochromocytoma and paraganglioma (PPGL).

METHODS

This retrospective cohort study included adult patients who underwent PPGL surgery with pathologic confirmation. The primary endpoint was the occurrence of postoperative hypoglycemia. Pre- and intraoperative clinical variables were collected. Independent risk factors for postoperative hypoglycemia were identified using multivariate logistic regression analysis, and a predictive model along with a nomogram was constructed and validated.

RESULTS

A total of 346 PPGL patients were enrolled. Postoperative hypoglycemia occurred in 45 patients (13.0%), with 35 cases (83.3%) occurring within 24 h after surgery. Multivariate analysis identified age < 30 years (odds ratio [OR] 3.091, 95% confidence interval [CI] 1.145-8.344, P= .026), history of chronic kidney disease (OR 3.253, 95% CI 1.213-8.725, P= .019), preoperative typical symptoms (defined as the presence of at least one of the classic triad: headaches, palpitations, or sweating) (OR 2.207, 95% CI 1.119-4.355, P= .022), preoperative positive semi-quantitative urine glucose (OR 2.986, 95% CI 1.063-8.390, P= .038), and adrenal tumor (OR 3.224, 95% CI 1.208-8.604, P= .019) as independent risk factors for postoperative hypoglycemia. The area under the receiver operating characteristic curve for the predictive model was 0.734 (95% CI 0.659-0.809). Calibration plots suggested good consistency between the predicted and actual risk. The final model was visualized via a nomogram.

CONCLUSIONS

Clinical factors were independently associated with the occurrence of postoperative hypoglycemia in PPGL. The visual nomogram developed in this study aided in predicting the risk of postoperative hypoglycemia in PPGL patients.