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Preoperative alpha‐blockade in phaeochromocytoma and paraganglioma: is it always necessary?
Author(s) -
Isaacs Michelle,
Lee Paul
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13284
Subject(s) - blockade , paraganglioma , pheochromocytoma , medicine , orthostatic vital signs , catecholamine , endocrinology , blood pressure , surgery , receptor
Summary Resection of phaeochromocytoma and paraganglioma ( PPGL ) is traditionally preceded by alpha‐blockade to prevent complications of haemodynamic instability intraoperatively. While there is general agreement on preoperative alpha‐blockade for classic PPGL s presenting with hypertension, it is less clear whether alpha‐blockade is necessary in predominantly dopamine‐secreting tumours, normotensive PPGL s, as well as tumours that appear to be biochemically ‘silent’. Preoperative management of these ‘atypical’ PPGL s is challenging and the treatment approach must be individualized, carefully weighing the risk of intraoperative hypertension against the possibility of orthostatic and prolonged postoperative hypotension. Consideration of antihypertensive medication pharmacology in the light of catecholamine physiology and PPGL secretory profile will facilitate the formulation of individualized preoperative preparatory strategies.

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