Feocromocitoma o paraganglioma (PPGL) hormonalmente funcional programado para resección quirúrgica. El exceso de catecolaminas genera un riesgo cardiovascular perioperatorio grave; se requiere una preparación preoperatoria estructurada antes de que el tumor pueda extirparse de manera segura.
Todos los pacientes con un PPGL hormonalmente funcional requieren un ciclo de bloqueo preoperatorio, que generalmente se extiende de 7 a 14 días antes de la cirugía. El protocolo especifica una clase preferida de primera línea de bloqueante adrenérgico, las condiciones bajo las cuales puede añadirse una segunda clase y las medidas obligatorias de reposición de volumen para contrarrestar los efectos hemodinámicos del exceso de catecolaminas.
DOI: 10.1210/jc.2014-1498
We recommend that all patients with a hormonally functional PPGL should undergo preoperative blockade to prevent perioperative cardiovascular complications.
We suggest α-adrenergic receptor blockers as the first choice.
We recommend preoperative medical treatment for 7 to 14 days to allow adequate time to normalize blood pressure and heart rate.
Treatment should also include a high-sodium diet and fluid intake to reverse catecholamine-induced blood volume contraction preoperatively to prevent severe hypotension after tumor removal.
Preoperative coadministration of β-adrenergic receptor blockers is indicated to control tachycardia only after administration of α-adrenergic receptor blockers.
Based on retrospective studies and institutional experience, a target blood pressure of less than 130/80 mm Hg while seated and greater than 90 mm Hg systolic while standing seems reasonable, with a target heart rate of 60–70 bpm seated and 70–80 bpm standing.
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