Endocrine Abstracts

JOINT2784

Introduction: Pheochromocytomas and paragangliomas (PPGL) are characterized by a wide spectrum of clinical and biological manifestations, primarily due to the excessive secretion of catecholamines. One of the common associated co-morbidities are glucose metabolism disorders, including both prediabetes and diabetes. The purpose of this study was to assess the prevalence of glycemic disorders observed in patients with PPGL.

Materials and Methods: We conducted a bicentric retrospective study in the endocrinology departments at two hospitals: Fattouma Bourguiba Hospital in Monastir and Farhat Hached Hospital in Sousse, Tunisia. This study included patients diagnosed with PPGL from January 1991 to December 2023.

Results: Out of the 54 patients included, 45 were diagnosed with PHEO, 8 with PGL, and 1 with both PHEO and PGL. We noticed a female predominance with sex ratio of 2.8. The median age of patients with PHEO and PGL was 46.4 and 49.2 years respectively. The mean BMI was 25 kg/m². A significant proportion of patients (75.9%) had hypertension, 37% had diabetes, while 25.9% had prediabetes.

Discussion: The glycemic disorders in patients with PPGL can be explained by multiples mechanisms. First, a defect in insulin secretion secondary to stimulation of α2 receptors, which inhibits insulin production (1,2) and second, insulin resistance through stimulation of α1 receptors, which activates lipolysis and gluconeogenesis (1,3). Elenkova et al. reported 30.4% for diabetes and 19.1% for prediabetes (4) and the Indian study by Khatiwada et al. described a higher rate of diabetes at 48.3% (3). We suggest that a comprehensive clinical examination, including glycemic screening, is crucial in the management of PPGL patients, especially considering the associated metabolic risks.

Conclusion: PPGL present a complex diagnostic and therapeutic challenge due to their highly variable clinical presentation and associated comorbidities, such as glycemic disorders and hypertension. Our study demonstrates a high prevalence of both prediabetes and diabetes in patients with PPGLs, underscoring the need for careful monitoring and management of glucose metabolism.

References: 1. Abe I, Differences in the actions of adrenaline and noradrenaline with regard to glucose intolerance in patients with pheochromocytoma. Endocr J. 2019;66(2):187–92. 2. Moustaki M. Secondary diabetes mellitus in pheochromocytomas and paragangliomas. Endocrine. 20 sept 2023;82(3):467–79. 3. Khatiwada S, Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion/sensitivity and predictors of remission. Diabetes Metab Syndr Clin Res Rev. nov 2020;14(6):2169–75. 4. Elenkova A, Prevalence and progression of carbohydrate disorders in patients with pheochromocytoma/paraganglioma: retrospective single-center study. Ann Endocrinol. févr 2020;81(1):3–10.