Risk factors for hemodynamic instability in patients with pheochromocytoma: a meta-analysis and systematic review

Background Pheochromocytomas and paragangliomas (PPGLs), catecholamine - secreting tumors from the adrenal medulla, can cause hypertension and other hemodynamic abnormalities. Patients with PPGLs are prone to hemodynamic instability (HI) during and after surgery, which can impact treatment and prognosis, so it is crucial to identify HI risk factors. Methods We searched multiple databases (Cochrane Library, Wanfang, Web of Science, PubMed, Embase, CNKI, and VIP) up to February 24, 2025. The Newcastle-Ottawa Scale was used to assess study quality. The Stata 15.0 software was used for meta-analyses with random-effects or fixed-effects models to calculate pooled odds ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results Twenty-three case-control studies involving 2,560 individuals were included. The following were identified as significant risk factors for HI in individuals with PPGLs: age [ P = 0.000]; presence of PPGLs symptoms [ P = 0.004]; history of diabetes mellitus [ P = 0.004]; coronary artery disease (CAD) [ P = 0.020]; preoperative α-blocker use [ P = 0.001]; preoperative β-blocker use [ P = 0.018]; tumor size [ P = 0.000]; American Society of Anesthesiologists > II [ P = 0.001]; mean 24 h urinary epinephrine [ P = 0.003]; mean 24 h urinary norepinephrine [ P = 0.024]; mean 24 h urinary metanephrine [ P = 0.003]; mean 24 h urinary normetanephrine [ P = 0.000]; normalized epinephrine/metanephrine [ P = 0.000]; longer anesthesia duration [ P = 0.044]; longer operative time [ P = 0.025]. Conclusions This study has found several risk factors for HI in PPGL patients, including older age, presence of PPGLs symptoms, history of diabetes or CAD, preoperative use of α-blocker or β-blocker, bigger tumor size, longer anesthesia durations and operation durations, ASA grade > II and bigger mean 24-hour urinary catecholamine metabolites. Clinicians should focus on these factors during perioperative management, develop individualized treatment plans to reduce HI risk, and enhance patient outcomes. Trial registration Not applicable.