Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: A cross-sectional study

Annika M.A. Berends*, Edward Buitenwerf, Ineke J. Riphagen, Jacques W.M. Lenders, Henri J.L.M. Timmers, Schelto Kruijff, Thera P. Links, Anouk N.A. van der Horst-Schrivers, Coen A. Stegeman, Elisabeth M.W. Eekhoff, Richard A. Feelders, Eleonora P.M. Corssmit, Ronald Groote Veldman, Harm R. Haak, Anneke C.Muller Kobold, Michiel N. Kerstens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Despite adequate presurgical management, blood pressure fluctua tions are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a larg e extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B -type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of card iovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with bl ood pressure fluctuations during PPGL resection. Methods: Study subjects participated in PRESCRIPT, a randomized control led trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents duri ng surgery as well as the occurrence of perioperative cardiovascular events. Results: A total of 126 PPGL patients were included. Median plasma conc entrations of MR-proADM and NT-proBNP were 0.51 (0.41-0.63) nmol/L and 68.7 (27.9-150.4) ng/L, respec tively. Neither MR-proADM nor NT-proBNP were associated with blood pressure fluctuations. There was a positiv e correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 0.44, P = 0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR: 5.46, P = 0.013 and OR: 1.54, P = 0.017, respectively). Conclusions: Plasma MR-proADM or NT-proBNP should not be considered as biom arkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.

Original languageEnglish
Pages (from-to)507-514
Number of pages8
JournalEuropean Journal of Endocrinology
Volume185
Issue number4
DOIs
Publication statusPublished - 27 Aug 2021

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