In patients with adrenal pheochromocytoma, medical therapy is initiated to stabilise blood pressure and heart rate before definitive management. When that medical optimisation has been attempted but the target thresholds remain unmet, the clinical pathway moves to the next defined step.
The preceding step involved adding a calcium channel blocker (nifedipine or amlodipine) to α-adrenergic receptor blockade, with metyrosine as a possible adjunct. That regimen failed to achieve the required blood pressure of less than 130/80 mm Hg seated and greater than 90 mm Hg systolic standing, with a heart rate of 60–70 bpm seated and 70–80 bpm standing.
The protocol at this stage involves a surgical intervention targeting the adrenal gland, carried out via a minimally invasive technique. The full specification — including patient selection criteria, procedural details, and peri-operative considerations — is in the structured protocol.
Partial overview only. Full protocol behind the link below.We recommend minimally invasive adrenalectomy (eg, laparoscopic) for most adrenal pheochromocytomas.
DOI: 10.1210/jc.2014-1498
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