When a phaeochromocytoma or paraganglioma triggers an adrenergic crisis, the resulting hypertensive emergency requires a management approach specifically tailored to the catecholamine-driven mechanism — standard antihypertensive strategies may be insufficient or inappropriate.
Clinical scenario: Catecholamine excess from a phaeochromocytoma or paraganglioma precipitates an adrenergic crisis, driving acute, severe blood pressure elevation. The underlying cause fundamentally shapes which agents are appropriate and which must be avoided.
The priority is rapid intravenous alpha-1 blockade to counteract the catecholamine surge. The specific agents, selection criteria, and approach are set out in the full structured protocol — access it below.
Adrenergic crises cause hypertensive emergencies and should be treated with an intravenous (i.v.) alpha-1-blocker, such as phentolamine, doxazosin or terazosin, or labetalol.
When given i.v. (1–2 mg/kg) twice weekly as a bolus over 1 min followed by a continuous infusion, labetalol also has alpha-blocker properties and has the advantage of allowing titration of the infusion based on the BP response, and avoids tachycardia via beta-blockade.
DOI: 10.1093/eurheartj/ehae178
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