Prevalence and progression of carbohydrate disorders in patients with pheochromocytoma/paraganglioma: retrospective single-center study
Prevalence and progression of carbohydrate disorders in patients with pheochromocytoma/paraganglioma: retrospective single-center study
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DOI：
10.1016/j.ando.2020.01.001
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发表时间：
2020-02-01
影响因子：
3.1
通讯作者：
Zacharieva, Sabina
中科院分区：
文献类型：
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作者：
Elenkova, Atanaska;Matrozova, Joannna;Zacharieva, Sabina
背景。-碳水化合物紊乱是最常见的代谢紊乱，影响了相当比例的嗜铬细胞瘤患者。-一项回顾性研究评估了40年间（1978-2017）在单一专科三级中心诊断的组织学证实的嗜铬细胞瘤204例患者（92例男性，112例女性）碳水化合物疾病的患病率和进展情况。肿瘤切除后随访100例。- 49.5%的病例被诊断为碳水化合物紊乱：30.4%患有糖尿病，19.1%患有前驱糖尿病。与糖耐量正常的受试者相比，患有碳水化合物紊乱的受试者在诊断时年龄较大，24小时尿中肾上腺素和去甲肾上腺素浓度也较高。三分之一的糖尿病患者接受口服治疗后血糖控制良好（54%接受二甲双胍单药治疗）。三分之一的患者需要术前胰岛素治疗。术后随访（100例患者，平均5年时间）显示糖尿病患病率降低（13%对33%，P=0.0007），糖尿病前期患病率降低（12%对24%，P=0.027）。几乎60%最初被诊断为碳水化合物紊乱的受试者在手术后恢复了正常的葡萄糖耐量；这些受试者术前尿肾上腺素/去甲肾上腺素水平明显高于持续性糖尿病/前驱糖尿病患者。相关分析显示尿中肾上腺素/去甲肾上腺素浓度与碳水化合物紊乱结局呈中度负相关（Spearmen’s Rho = - 0.507； P=0.013）。术前和术后肥胖症患病率（15% vs. 16%， P=0.845）和血脂异常患病率（46% vs. 39%， P=0.316）差异无统计学意义。-碳水化合物紊乱影响约50%的嗜铬细胞瘤患者；30%的患者发展为显性糖尿病，这在一些罕见的病例中可能是唯一的临床表现。嗜铬细胞瘤相关性糖尿病更容易影响肾上腺素分泌为主的患者。它通常很容易控制，通常需要口服抗糖尿病治疗。碳水化合物紊乱的可逆性取决于严重程度、术前肾上腺素水平、年龄和体重。(C) 2020 Elsevier Masson SAS。版权所有。
Background. - Carbohydrate disorders are the most frequent metabolic disorders, affecting a significant proportion of patients with pheochromocytoma.Objective. - A retrospective study assessed the prevalence and progression of carbohydrate disorders in 204 patients (92 men, 112 women) with histologically proven pheochromocytoma diagnosed in a single specialized tertiary center during a 40-year period (1978-2017). One hundred were followed-up after tumor removal.Results. - Carbohydrate disorders were diagnosed in 49.5% of cases: 30.4% with diabetes and, 19.1% prediabetes. Subjects with carbohydrate disorders had significantly greater age at diagnosis and higher 24-hour urine metanephrine and normetanephrine concentrations than those with normal glucose tolerance. One-third of patients with diabetes achieved good glycemic control under oral treatment (54% on metformin monotherapy). One-third of patients overall required preoperative insulin treatment. Postoperative follow-up (100 patients; 5-year mean duration) showed reduced prevalence of diabetes (13% vs. 33%; P=0.0007) and prediabetes (12% vs. 24%; P=0.027). Almost 60% of subjects initially diagnosed with carbohydrate disorders recovered normal glucose tolerance after surgery; these subjects had significantly higher preoperative urine metanephrine/normetanephrine levels than those with persistent diabetes/prediabetes. Correlation analysis revealed a moderate negative relationship between urine metanephrine/normetanephrine concentration and the outcome of the carbohydrate disorders (Spearmen's Rho = - 0.507; P=0.013). There was no significant difference according to pre- or postoperative prevalence of obesity (15% vs. 16%; P=0.845) or dyslipidemia (46% vs. 39%; P=0.316).Conclusions. - Carbohydrate disorders affect approximately 50% of pheochromocytoma patients; 30% develop overt diabetes, which may be the only clinical manifestation in some rare cases. Pheochromocytoma-related diabetes is more likely to affect patients with predominant adrenaline secretion. It is often easy to control and usually requires oral antidiabetic treatment. Reversibility of carbohydrate disorders depend on severity, preoperative metanephrine level, age and weight. (C) 2020 Elsevier Masson SAS. All rights reserved.