This protocol addresses patients with a secreting metastatic pheochromocytoma or paraganglioma who develop hypertensive emergency or urgency as a direct consequence of catecholamine excess. The cardiovascular burden in this setting is driven by the hormonal activity of the tumour.
The hormonal manifestations of metastatic pheochromocytoma/paraganglioma are predominantly cardiovascular. Hypertensive emergency or urgency is among the recognised acute presentations alongside other serious catecholamine-mediated events.
Acute management relies on intravenous antihypertensive agents appropriate for the catecholamine-excess state, with additional agents considered as the clinical picture requires.
DOI: 10.1097/MPA.0000000000001792
The hormonal manifestations of mPPGL are mainly cardiovascular and include catecholamine-induced cardiomyopathy (takotsubo), myocardial infarction, hypertensive emergency or urgency, shock, syncope, arrhythmia, dissecting aortic aneurysm, acute kidney injury, and hemorrhagic or ischemic stroke.
Intravenous agents if needed include nicardipine, phentolamine, magnesium sulfate, and nitroprusside with addition of a β-blocker as needed.
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