Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas.

CONTEXT: The per-operative hemodynamic behavior of normotensive incidentally discovered pheochromocytomas is poorly documented. OBJECTIVE: To compare the per-operative hemodynamic instability and early postoperative outcome of normotensive pheochromocytomas, hypertensive pheochromocytomas, and benign non-pheochromocytoma adrenal incidentalomas (AIs). DESIGN: Retrospective cohort treated in a single center. PATIENTS AND METHODS: Fifty patients (10 normotensive pheochromocytomas, 24 hypertensive pheochromocytomas, and 16 AIs) were anesthetized and operated on by the same team, using laparoscopy in 78% of cases. Before surgery, 60% of normotensive and 95.8% of hypertensive pheochromocytomas received pretreatment with α-receptor or calcium channel blockers. All of the patients received the same intraoperative hemodynamic monitoring, including continuous direct intra-arterial pressure recording. RESULTS: All the features of hemodynamic instability, with the exception of the diastolic pressure nadir and fluid volume requirements, differed between hypertensive pheochromocytomas and AIs. Conversely, all features of hemodynamic instability were similar in hypertensive and normotensive pheochromocytomas. More specifically, by comparison with AIs, normotensive pheochromocytomas displayed higher maximal systolic pressure; more hypertensive, severe hypertensive, and hypotensive episodes; and a higher minimal heart rate, and also required more interventions to treat undesirable blood pressure elevations. Postoperative complications, all of which were mild, were more frequent in hypertensive pheochromocytomas than in normotensive pheochromocytomas (P < .03). CONCLUSIONS: Normotensive pheochromocytomas have roughly comparable per-operative hemodynamic instability to hypertensive pheochromocytomas and differ markedly from non-pheochromocytoma AIs. It is therefore crucial to identify normotensive pheochromocytomas among AIs when surgery is scheduled and to apply the standard of care for pheochromocytoma anesthesia.

Low physical activity in patients with type 2 diabetes: the role of obesity.

AIMS: Few studies have described ambulatory activity in free-living individuals with type 2 diabetes mellitus (T2DM) using motion sensors, and none included a control group. For this reason, our study compared the physical-activity levels of outpatients with T2DM with subjects without diabetes, and examined the relationship between body mass index (BMI) and physical-activity parameters. METHODS: Physical-activity levels in 70 outpatients with T2DM and 30 age-, gender- and employment-matched individuals without diabetes were measured using the SenseWear Armband™, a monitoring device validated against doubly labelled water, to assess total energy expenditure. Patients wore the SenseWear Armband™ on their right arm continuously every day for 1 week. RESULTS: Total energy expenditure (<300 kcal/day), number of steps (<1500/day), physical-activity duration (<130 min/day) and active energy expenditure/day (<300 kcal) were all significantly lower (P<0.05) in patients with T2DM. These measures were inversely correlated with BMI, and remained significant after adjusting for age, gender, employment status and the presence of diabetes. CONCLUSION: Outpatients with T2DM have lower physical-activity levels than their matched controls, a characteristic that is related to their higher BMI.