Preoperative alpha-blockade in phaeochromocytoma and paraganglioma: is it always necessary?

Clin Endocrinol (Oxf). 2017 Mar;86(3):309-314. doi: 10.1111/cen.13284. Epub 2016 Dec 15.

Abstract

Resection of phaeochromocytoma and paraganglioma (PPGL) is traditionally preceded by alpha-blockade to prevent complications of haemodynamic instability intraoperatively. While there is general agreement on preoperative alpha-blockade for classic PPGLs presenting with hypertension, it is less clear whether alpha-blockade is necessary in predominantly dopamine-secreting tumours, normotensive PPGLs, as well as tumours that appear to be biochemically 'silent'. Preoperative management of these 'atypical' PPGLs is challenging and the treatment approach must be individualized, carefully weighing the risk of intraoperative hypertension against the possibility of orthostatic and prolonged postoperative hypotension. Consideration of antihypertensive medication pharmacology in the light of catecholamine physiology and PPGL secretory profile will facilitate the formulation of individualized preoperative preparatory strategies.

Publication types

  • Review

MeSH terms

  • Adrenergic alpha-Antagonists / therapeutic use*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / prevention & control*
  • Intraoperative Complications / drug therapy
  • Intraoperative Complications / prevention & control*
  • Paraganglioma / drug therapy
  • Paraganglioma / surgery
  • Pheochromocytoma / drug therapy
  • Pheochromocytoma / surgery
  • Precision Medicine / economics
  • Precision Medicine / methods
  • Preoperative Care / methods

Substances

  • Adrenergic alpha-Antagonists