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Predicción de fluctuaciones hemodinámicas durante la adrenalectomía para feocromocitoma
Marina Stojanovic1,2,3, Magdalena Grujanic2, Anka Toskovic2,3
1Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Diagnostics (Basel, Switzerland)
|January 28, 2026
Resumen
La cirugía de feocromocitoma puede causar caídas de la presión arterial. Los tumores más grandes y los altos volúmenes de líquidos durante la cirugía predicen hipotensión, lo que resalta la necesidad de una monitorización y manejo cuidadosos del paciente durante la adrenalectomía.
Área de la Ciencia:
- Endocrinología
- Oncología Quirúrgica
- Anestesiología
Sus antecedentes:
- El feocromocitoma, un raro tumor suprarrenal, causa exceso de catecolaminas, lo que lleva a inestabilidad hemodinámica perioperatoria.
- La hipotensión intraoperatoria sigue siendo una complicación significativa a pesar de los avances anestésicos y quirúrgicos.
- Predecir y manejar la inestabilidad hemodinámica durante la adrenalectomía es crucial para la seguridad del paciente.
Objetivo del estudio:
- Identificar predictores preoperatorios e intraoperatorios de inestabilidad hemodinámica durante la adrenalectomía por feocromocitoma.
- Mejorar las estrategias de manejo intraoperatorio para pacientes con feocromocitoma.
- Mejorar la seguridad del paciente y los resultados perioperatorios.
Principales métodos:
- Análisis retrospectivo de pacientes adultos sometidos a adrenalectomía por feocromocitoma.
- Inclusión de datos preoperatorios, características del tumor (TC/RM), abordaje quirúrgico y hemodinámica intraoperatoria.
- Análisis de regresión logística para determinar los predictores de hipotensión intraoperatoria (MAP < 60 mmHg).
Principales resultados:
- La hipotensión intraoperatoria ocurrió en el 51% de los pacientes.
- El tamaño tumoral más grande (diámetro ≥ 49 mm) y la alta infusión de líquidos intraoperatorios (≥ 1200 mL/h) fueron predictores independientes de hipotensión.
- Los niveles preoperatorios de catecolaminas y el abordaje quirúrgico no fueron predictores significativos.
Conclusiones:
- El tamaño del tumor es un predictor clave de la inestabilidad hemodinámica intraoperatoria en la adrenalectomía por feocromocitoma.
- La evaluación preoperatoria individualizada y el manejo de líquidos intraoperatorios son esenciales.
- La optimización del manejo puede reducir el riesgo de hipotensión y mejorar los resultados perioperatorios.
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