Changes in clinical features and long-term prognosis in patients with pheochromocytoma

To investigate changes in preoperative clinical features and the long-term outcome of tumor recurrence, mortality, and morbidity in patients with pheo chromocytoma, we retrospectively examined changes in the clinical features by comparing 49 patients from 1957 to 1985 (group I) with 46 patients from 1986 to December 1995 (group II). In addition in these 95 patients (excludi ng 2 who had died before operation), we evaluated long-term postoperative o utcome from the initial operation to August 1996 (909 patient-years). The m ean age in group II was older than that of group I. The percentage of patie nts having proteinuria or hypertensive retinopathy in group II was less tha n that in group I. Of 20 patients with incidentally discovered pheochromocy toma, 7 (35%) were greater than or equal to 60 years old, 7 asymptomatic, a nd 11 (55%) normotensive. Plasma and urinary catecholamines in these patien ts were significantly (P < .01) lower than in patients with pheochromocytom a having typical clinical features. Long-term cohort study showed 14 deaths . Relative survival rates were 91% at 5 years and 83% at 10 years and uncha nged thereafter. The Kaplan-Meier estimate of pheochromocytoma-free surviva l was shorter in patients with a larger-than-median (60 g) tumor weight. Si x patients had malignant recurrence 3 to 101 months (median, 45 months) aft er the initial operation. Of 65 patients confirmed alive at follow-up, II w ere hypertensive. In the Cox model hypertension-free survival was not assoc iated with age, a family history of hypertension, duration of hypertension, or creatinine clearance. Pheochromocytoma should be diagnosed from a wide spectrum of clinical featu res including those that are not generally suspected of resulting from exce ss catecholamines or hypertension, and after surgery, patients with this di sease should be followed-up carefully for a long period (at least 10 years) because of the risk of tumor recurrence and the high prevalence of disease . (C) 2000 American Journal of Hypertension, Ltd.