Catecholamine release induces elevation in plasma lactate levels in patients undergoing adrenalectomy for pheochromocytoma

• The relationship between preoperative catecholamine levels and intraoperative peak plasma lactate levels were studied in patients who underwent adrenalectomy for pheochromocytoma.
• Catecholamine release from the tumor by surgical manipulation is one of major causes of complications, hindering perioperative management.
• Intraoperative peak plasma lactate level was correlated with preoperative epinephrine-releasing activity.
• Catecholamine release from surgical manipulation may be a cause of intraoperative transient lactic acidosis.
• Catecholamine release should be thought of as a differential diagnosis of intraoperative lactic acidosis.

Study ObjectiveTo determine the relationship between preoperative catecholamine levels and intraoperative peak plasma lactate levels in patients who underwent adrenalectomy for pheochromocytoma.DesignRetrospective observational study.SettingOperating room in one university hospital.MeasurementsThe records of 27 ASA physical status 1 and 2 patients who underwent adrenalectomy for pheochromocytoma were studied. Preoperative catecholamine levels and intraoperative plasma lactate levels were recorded.Main ResultsTwenty cases had high lactate levels (> 2 mmol/L). Preoperative urine epinephrine levels and urine metanephrine levels showed a moderate correlation with intraoperative peak plasma lactate levels (rs = 0.475 and rs = 0.499, respectively; Spearman’s rank correlation test). Receiver operating characteristic (ROC) curve analysis for preoperative urine epinephrine levels showed good performance for prediction of high lactate levels [> 2 mmol/L, area under the curve (AUC) = 0.800], whereas ROC for preoperative urine norepinephrine levels showed no predictive performance for high lactate levels.ConclusionsCatecholamine release caused by surgical manipulation may be a possible cause of intraoperative transient lactic acidosis, and it should be considered as a differential diagnosis of intraoperative lactic acidosis. Intraoperative peak plasma lactate level was correlated with preoperative epinephrine-releasing activity.