Analysis Of Clinical Characteristics And Significance Of SDHB Gene Expression In Silent Pheochromocytoma

Objective With the improvement of imaging,medical testing and genetic screening technology,more and more adrenal masses are screened out during physical examination.It is not uncommon to find such tumors.It is generally believed that the incidence of silent pheochromocytoma is about 3 % To 10%,and even reported in the literature up to about 30%.However,the specificity of this type of tumor and the relatively lack of clinical diagnosis and treatment experience at present.Misdiagnosis and missed diagnosis are common.These patients are usually asymptomatic,under stress conditions,especially when the preoperative awareness and preparation are insufficient,sudden blood pressure fluctuations or even acute cardiovascular events occur,which further increases the mortality of the disease and also affects the patients.Silent pheochromocytoma mainly refers to pheochromocytoma which has no clinical manifestations such as elevated blood pressure,palpitation and sweating,but has a rapid rise in blood pressure or stable blood pressure under severe trauma,infection,surgery and other stress conditions.In this study,the baseline data,clinical manifestations,biochemical hormone indexes,imaging and pathological features of silent pheochromocytoma group and dominant pheochromocytoma group were compared,and the expression of SDHB in the two groups was further discussed to explore the clinical differences of silent pheochromocytoma so as to find the best treatment for occasional adrenal space occupying patients.Methods A total of 234 patients who had been diagnosed with pheochromocytoma after pathological diagnosis from January 2000 to December 2018 in the Department of Urology at affiliated hospital of Qingdao University were collected,and 234 patients who met the study inclusion criteria were selected from all clinical Information and pathology information.And according to whether there are "triple syndrome",hypertension and other obvious clinical manifestations are divided into resting pheochromocytoma research group,dominant symptoms of pheochromocytoma control group.The baseline data,clinical manifestations,biochemical hormone indicators,imaging and other data of the two groups were recorded and collated,and retrospective study comparisons between the groups were carried out,focusing on summarizing the characteristics of resting pheochromocytoma.The postoperative pathological sections of the two groups of patients were collected,and the wax sections of the specimens were searched for immunohistochemical staining to compare the differences of SDHB expression in the two groups.Results A total of 234 patients with pheochromocytoma were enrolled in this study,including 127 males and 107 females.The age of onset was 13-79 years,the average age was 45.2±14.3 years,and the median duration was 2.7 years.All patients had undergone laparoscopic retroperitoneal swelling Biopsy,postoperative pathology showed pheochromocytoma.Resting pheochromocytoma accounts for 20.1%(47/234)of the total pheochromocytoma,imaging is the main discovery route,30 males and 17 females,the age of onset is 15-78 years,the average age is 47.6 ± 12.4 years,The BMI was 23.7;the average systolic blood pressure was 117.6±16.3 mm Hg,and the average diastolic blood pressure was 78.8±11.5 mmHg,which were all within the normal range.None of the patients developed "triple syndrome",paroxysmal hypertension,or persistent hypertension;Adrenaline(74.6±135.2)g/24 h,urinary adrenaline(242.5±474.1)g/24 h,urinary dopamine(294.4±313.2)g/24h;all lower than the dominant symptomatic pheochromocytoma group;47 Of the resting PCCs,45(95.8%)were located in the adrenal gland,20 on the left(42.6%),24 on the right(51.1%),and 1 on both sides(2.1%).Two cases(4.3%)were located outside the adrenal glands,including 2 cases retroperitoneally and 2 cases located in the renal hilum.CT results showed that the two groups of pheochromocytoma were heterogeneous in density under CT,most of them had a complete capsule,uneven patchy enhancement was seen during the enhancement phase,and sometimes cystic changes,calcification,bleeding,etc.were seen.There was no significant difference in the choice of surgical methods between the two groups.The resting PCC has a smaller volume,a shorter diameter,and less vascular invasion.SDHB is less expressed in resting pheochromocytoma.In addition,the two groups were not significantly different in other respects.Conclusion Silent pheochromocytomas are not uncommon and the proportion may be much higher than that reported at present,and imaging is the main way to find it,the tumor is small in size and has no typical symptom of sweating,severe headache and palpitation.Accompanied by paroxysmal,persistent or worsening hypertension and other symptoms.Misdiagnosis is common.Whether adrenal or extra-adrenal tumor has normal blood pressure,the possibility of silent pheochromocytoma should be considered.Surgery is an effective way of treatment,and full perioperative preparation and intraoperative monitoring are needed to reduce misdiagnosis and intraoperative blood pressure fluctuation.Reduce the risk factors that appear during surgery,so that patients get a better prognosis.