This protocol applies to patients with a pheochromocytoma that is larger than 6 cm or that is invasive, in whom the blood pressure and heart rate targets of the prior management step have not been achieved.
The patient has a pheochromocytoma with a tumor diameter greater than 6 cm, or an invasive pheochromocytoma. This presentation defines a specific subset in which the standard approach to preoperative hemodynamic stabilisation has not reached the required thresholds.
The preceding step involved α-adrenergic receptor blockade with the addition of a calcium channel blocker, and where appropriate, α-methyl-paratyrosine (metyrosine) as further add-on therapy.
That line targets normalised blood pressure — less than 130/80 mmHg while seated and greater than 90 mmHg systolic while standing — with a heart rate of 60–70 bpm seated and 70–80 bpm standing. When those goals are not met, this protocol represents the next escalation step.
A specific surgical approach is recommended for this scenario to ensure complete tumor removal and prevent local complications. The full protocol details the procedure selection and its clinical rationale for large or invasive disease.
DOI: 10.1210/jc.2014-1498
We recommend open resection for large (eg, >6 cm) or invasive pheochromocytomas to ensure complete tumor resection, prevent tumor rupture, and avoid local recurrence.
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