Endocrine Abstracts

JOINT2450

Introduction: Pheochromocytomas and paragangliomas (PPGLs) can cause serious cardiovascular events induced by the unpredictable release of large amounts of catecholamines.

Purpose: The aim of this study was to determine possible prognostic factors of catecholamine-induced cardiovascular events for timely diagnosis, better risk stratification and optimal treatment strategy in patients diagnosed with PPGL.

Methods: A literature search for eligible studies on PubMed and the Cochrane Library from January 1980 until November 2024 was performed. The primary endpoint was any serious cardiovascular event (Takotsubo syndrome, acute coronary syndrome, acute heart failure, cardiogenic shock, stroke or fatal arrhythmias) in PPGL patients. Meta-analysis of potential prognostic factors of major adverse cardiovascular events (MACEs) after assessment of clinical, laboratory, imaging, histological and genetic parameters was performed on the pooled data.

Results: Quantitative data from nine retrospective cohort studies, involving 1566 patients with PPGL were included in the analyses. MACEs were manifested in 302 patients [pooled estimate 21% (95% C.I. 14–29%)], among whom there were 95 patients with Takotsubo syndrome [pooled estimate 39% (23–54%)] of overall cardiovascular events. There was no sufficient data to determine the prevalence of the other types of cardiovascular events while significant heterogeneity was detected for all effect estimates. An increased risk of MACEs was noted in patients presenting with tumors with necrosis/hemorrhage (71%; 95C.I. 27– 115%) and in those with diabetes (56%; 95C.I. 2–109). As expected, dyspnea and chest pain were prominent risk factors for MACE as they were associated with a 5 (95% C.I. 3.3–7.4) and 2.7 (95% C.I. 1.5–4) times increased risk of serious cardiovascular event development, respectively. The pooled results did not demonstrate any association between age, adrenergic phenotype, metastatic disease or familial PPGLs on serious cardiovascular outcomes. In conclusion, smaller sizes do not serve a protective factor, as MACEs are associated with a mean difference of only 8.3mm (95% C.I. 0.9–15.7 mm) in tumor size between the two groups.

Conclusion: To our knowledge, this is the first meta-analysis of cohort studies of catecholamine-induced MACEs in patients with PPGL. Our study shows that 21% of PPGL cases will develop MACE. Necrosis/hemorrhage, dyspnea, chest pain and diabetes are associated with an increased likelihood of development of serious cardiovascular events. However, these results should be interpreted with caution due to statistical and methodological heterogeneity.