This protocol applies to patients with hereditary pheochromocytoma and small tumors who have a history of contralateral complete adrenalectomy, and in whom standard preoperative α-adrenergic receptor blockade has not achieved the required blood pressure and heart rate targets.
The patient has hereditary pheochromocytoma with small tumors and has previously undergone a contralateral complete adrenalectomy. In this setting, preserving residual adrenal cortex is a priority to avoid permanent adrenal insufficiency, favouring a cortex-sparing surgical approach.
Initial management with α-adrenergic receptor blockade (with β-adrenergic receptor blockers added to control tachycardia after establishing adequate α-blockade) did not normalize blood pressure to below 130/80 mm Hg seated, did not achieve systolic pressure above 90 mm Hg standing, or did not reach the target heart rate range. This protocol addresses that insufficient control.
The protocol adds a calcium channel blocker as an adjunct to existing α-adrenergic receptor blockade to further improve blood pressure control. An additional preoperative option is also described for further perioperative stabilization. Specific agent selection, the complete criteria for each option, and full sequencing remain in the full protocol.
Complete regimen details — including agent selection and perioperative considerations — are available via the link below.
Blood pressure below 130/80 mm Hg while seated and above 90 mm Hg systolic while standing; heart rate of 60–70 bpm seated and 70–80 bpm standing.
DOI: 10.1210/jc.2014-1498