Pheochromocytoma in Paraganglioma: Next Step When α-Adrenergic Blockade Does Not Achieve Preoperative Blood Pressure Targets
A paraganglioma is a tumor derived from extra-adrenal chromaffin cells of the sympathetic paravertebral ganglia of the thorax, abdomen, and pelvis. When hormonally functional, it requires preoperative haemodynamic stabilisation before surgical resection — either open (the general preference) or laparoscopic in selected small, noninvasive tumors at surgically favourable locations.
Initial preoperative blockade with α-adrenergic receptor blockers — with β-adrenergic receptor blockers added to control tachycardia — did not achieve the required haemodynamic targets: seated blood pressure below 130/80 mm Hg, standing systolic above 90 mm Hg, and heart rate of 60–70 bpm seated / 70–80 bpm standing.
This protocol addresses what to do next.
Target haemodynamic state before proceeding to surgery: blood pressure below 130/80 mm Hg seated and above 90 mm Hg systolic standing, with a heart rate of 60–70 bpm seated and 70–80 bpm standing.
References
DOI: 10.1210/jc.2014-1498- A paraganglioma is a tumor derived from extra-adrenal chromaffin cells of the sympathetic paravertebral ganglia of thorax, abdomen, and pelvis.
- We suggest open resection for paragangliomas, but laparoscopic resection can be performed for small, noninvasive paragangliomas in surgically favorable locations.
- Calcium channel blockers are the most often used add-on drug class to further improve blood pressure control in patients already treated with 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.