Hormonally functional pheochromocytoma or paraganglioma (PPGL) scheduled for surgical resection. Catecholamine excess creates severe perioperative cardiovascular risk; structured preoperative preparation is required before the tumour can be safely removed.
All patients with a hormonally functional PPGL require a preoperative blockade course, typically running 7 to 14 days before surgery. The protocol specifies a preferred first-line class of adrenergic blocker, conditions under which a second class may be added, and mandatory volume repletion measures to counteract the haemodynamic effects of catecholamine excess.
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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