Controversies about the systematic preoperative pharmacological treatment before pheochromocytoma or paraganglioma surgery

in European Journal of Endocrinology
View More View Less
  • 1 Department of Endocrinology, Aix Marseille Université, APHM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Marseille, France
  • | 2 AP-HP, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
  • | 3 Université de Paris, Paris, France
  • | 4 PARCC, INSERM UMR970 and Reference Centre for Rare Adrenal Diseases, Paris, France
  • | 5 Department of Endocrine Surgery, APHM, La Conception Hospital, Marseille, France
  • | 6 Cardiology Department, APHM, HTA and Vascular Medicine University Hospital Timone, Marseille, France

Correspondence should be addressed to F Castinetti or L Amar; Email: frederic.castinetti@ap-hm.fr or laurence.amar@aphp.fr
Free access

The question of systematic use of a pharmacological treatment before surgery in patients diagnosed with pheochromocytoma and paraganglioma (PPGL) remains highly controversial. While recent guidelines suggest that this should be used in all patients, some experienced teams consider it unnecessary in some cases, provided the surgery is performed in a dedicated center that has expert endocrinologists, cardiologists, surgeons, and anesthetists. This controversy is aimed at shedding light on the potential benefits and risks of such a treatment, focusing specifically on alpha blockers which are considered as the first-line medical treatments in patients with PPGL. After discussing the rationale for alpha blockers, hemodynamic instability, tolerance, and acute cardiac complications will then be discussed in the first part of the manuscript, defending a systematic use. The second section will focus on blood pressure control, tolerance of alpha blockers, and also the management of normotensive PPGL, examining the daily risks of PPGL and arguing against the systematic use of a preoperative pharmacological treatment before surgery. Finally, we will discuss the concept of expert centers and define the patients in whom the risk/benefit profile would favor the use of this preoperative treatment.

Abstract

The question of systematic use of a pharmacological treatment before surgery in patients diagnosed with pheochromocytoma and paraganglioma (PPGL) remains highly controversial. While recent guidelines suggest that this should be used in all patients, some experienced teams consider it unnecessary in some cases, provided the surgery is performed in a dedicated center that has expert endocrinologists, cardiologists, surgeons, and anesthetists. This controversy is aimed at shedding light on the potential benefits and risks of such a treatment, focusing specifically on alpha blockers which are considered as the first-line medical treatments in patients with PPGL. After discussing the rationale for alpha blockers, hemodynamic instability, tolerance, and acute cardiac complications will then be discussed in the first part of the manuscript, defending a systematic use. The second section will focus on blood pressure control, tolerance of alpha blockers, and also the management of normotensive PPGL, examining the daily risks of PPGL and arguing against the systematic use of a preoperative pharmacological treatment before surgery. Finally, we will discuss the concept of expert centers and define the patients in whom the risk/benefit profile would favor the use of this preoperative treatment.

Introduction

While unstable hypertension should be controlled in patients with pheochromocytoma and paraganglioma (PPGL), the systematic use of preoperative pharmacological treatment, especially alpha receptor blockers, before surgery remains a matter for debate. In this manuscript, we will mainly address the need to treat all patients systematically with alpha receptor blockers before surgery. This is a major point of controversy, as shown by Luizet al. in their multicentric retrospective study, where the authors reported that only 69% of 381 patients operated for PPGL were managed according to US Endocrine Society Clinical Practice Guidelines (1, 2). Furthermore, the majority of the remaining patients were not treated with any drug or were treated with beta blockers (which are contra-indicated due to a risk of severe hypertensive crisis either before or concomitantly with alpha blockers) (3). In the US guidelines (1), as in the recent guidelines on the management of PPGL in the Journal of Hypertension (4), it was however stated that ‘Presurgical medical preparation using an α-adrenergic receptor blocker remains the mainstay for preventing life-threatening peri-operative cardiovascular complications’. Therefore, does the published data support the systematic use of alpha blockers prior to surgery?

FOR: There is a need for a systematic use of a pharmacological treatment

Alpha adrenergic receptor blockers: a pathophysiological basis

Surgery for PPGL is regarded as high risk, with a historical mortality rate exceeding 40% in some case series. However, the mortality rate is currently closer to 1%. The excess mortality was linked to the tumor size and the vascularization of the tumor, while specific risks were linked to epinephrine and norepinephrine hypersecretion. Indeed, norepinephrine stimulates both subtypes of α receptors, and β1 receptors, but has little activity on β2 receptors. Epinephrine stimulates both α and β adrenoreceptors. However, receptor activation is dose-dependent; β receptors are more sensitive and can be activated at lower concentrations, whereas α-activation requires higher levels of epinephrine. The stimulation of α-1 receptor by predominantly norepinephrine and/or epinephrine induces peripheral vasoconstriction and increases peripheral vascular resistance, leading to a marked increase in blood pressure. In PPGL, the hypersecretion of epinephrine and norepinephrine has two specific features. It can induce a massive catecholamine release into the circulation. Additionally, the specific nature of PPGL relies on the continuous or episodic release of epinephrine and norepinephrine. In this context, the use of alpha blockade has a clear pathophysiological basis.

Use of alpha blockers to prevent hemodynamic instability (HDI) during surgery

The main goal of preoperative management of PPGL is to normalize blood pressure and heart rate, restore effective circulating blood volume, improve metabolic condition, and prevent a catecholamine storm and HDI in patients during surgery (5). As these conditions are due predominantly to the release of norepinephrine, the use of alpha blockers seems obvious from a pathophysiological viewpoint as previously discussed. The use of alpha blockers prior to resection of a PPGL was first introduced in 1949 (6). Later, in 1999, Goldstein published a retrospective study of 108 patients operated for PPGL and showed that patients who did not receive alpha blockers had a higher rate of complications (69% vs 3%) than those who did (7). Since then, it has become part of routine clinical care for the management of patients with PPGL and is recommended in both International and European guidelines: ‘We recommend that all patients with a hormonally functional PPGL should undergo preoperative blockade to prevent perioperative cardiovascular complications. We suggest α -adrenergic receptor blockers as the first choice’. (1). More recently, ‘Presurgical administration of α-adrenergic receptor blockers is considered as the treatment of first choice’ (4), and ‘All patients with PPGL (even those with apparent normal levels of catecholamines) should receive appropriate preoperative medical management to block the effects of released catecholamines. Phenoxybenzamine, an α-adrenoceptor blocker, is most commonly used for preoperative control of blood pressure’ (8). Usually, preoperative treatment with alpha blockers is initiated 7–14 days before surgery. Treatment should be introduced using a gradual increase in dose depending on blood pressure. The goal is to block alpha adrenergic receptors to limit HDI and to help reduce blood pressure. Evidence from randomized, controlled clinical studies regarding the effectiveness of alpha blockers is unavailable. There are no placebo-controlled, randomized studies on this topic, and analysis of the literature shows conflicting results (9). All previous studies on the type of α-adrenergic receptor blocker were retrospective in design and suffered from several biases, including the use of historical controls and the lack of a well-defined perioperative management protocol. Many studies reported a decrease in preoperative blood pressure, a lower rate of reactive tachycardia, and better postoperative recovery (5, 10, 11, 12). A recently published meta-analysis, based on only four studies, showed that mortality, perioperative cardiovascular complications, mean maximal intraoperative systolic and diastolic blood pressure, and mean maximal intraoperative heart rate did not differ between patients with or without alpha blocker administration (13). However, this is probably due to the low risk of events in these studies. In addition, these four studies were conducted in expert centers, in which surgeons and anesthetists are trained to manage the blood pressure fluctuations that may occur during surgery, which could explain the low number of events in these series. Additionally, among these four studies, one concerned only normotensive patients (14) and the three others had selection bias (see below). At the end of the meta-analysis, the authors concluded that ‘The level of evidence is too low to conclude that the practice of preoperative α-blockade can safely be abandoned’ (13) and that randomized studies should be performed to generate the required evidence on this subject. One monocentric, pilot, open-label, randomized–controlled trial with the objective of comparing the efficacy of calcium channel blockers (CCB) and α-blockers on intraoperative HDI has been recently published. However, the results did not reach statistical significance as the authors initially decided to include 26 patients ‘based on feasibility’ and finally, only included 23 patients and analyzed the data from 20 patients (15). Moreover, the study protocol cannot be found in the clinicaltrials.gov database. In this context, without knowing the power, sample size determination, or hypothesis, the interpretation of the results of this pilot study appears impossible. Since all these studies were retrospective, there are multiple biases, the first being patient selection. Indeed, the decision of whether to initiate alpha adrenergic receptor blockade is likely to be affected by the severity of symptoms, the patient’s age and general condition, and the level of hypersecretion. Additionally, in most of the studies, the dose of alpha blockers was not specified and was likely too low to achieve efficacy, and the blood pressure target was not defined (16). For example, in the study by Groebenet al., the average daily dose of doxazosin was 11 mg (17), compared to an average dose of 40 mg/day in the only randomized study (18). Indeed, there is only one published randomized study and it compared phenoxybenzamine (non-selective and non-competitive α 1- and α 2-adrenergic receptor blocker) to doxazosin (selective and competitive α 1- and α 2-adrenergic receptor blocker). This study provides no information regarding the indication of alpha blockade vs another antihypertensive drug (or no antihypertensive drug). However, in this randomized study, which included 134 patients, the median cumulative time outside target blood pressure was approximately 11–12% during surgery, which is much lower than the time outside target blood pressure reported in other studies without alpha blockade. The median duration of pretreatment was 14 days, a CCB was administered in 40% of the patients, and 77% of the patients received metoprolol. During surgery, 50–70% of patients had a hypertensive peak with a systolic blood pressure > 160 mmHg. The duration of blood pressure outside the target range during the resection of a PPGL was not different after preoperative treatment with either phenoxybenzamine or doxazosin. Phenoxybenzamine was more effective in preventing intraoperative HDI, but it could not be established whether this was associated with a better clinical outcome. Phenoxybenzamine is also unavailable in some European countries.

The specific case of normotensive patients

Patients with hypersecretion of epinephrine/norepinephrine may have either permanent hypertension or acute elevations of blood pressure. First, the discussion among ‘normotensive patients with PPGL’ should exist only among patients who underwent an ambulatory blood pressure measurement (4). Besides, some studies have shown that patients with normotensive PPGL have the same per-operative HDI risk as hypertensive patients with PPGL (19). In this context, they should receive the same preparation for surgery as hypertensive patients. One can consider that prevalence of side effects would be higher among normotensive patients, but this has not been evaluated and additionally, patients would not receive this treatment over a long period. To conclude, analysis of the literature regarding the benefit of alpha blockade to prevent HDI shows conflicting results. The current literature thus does not help us to decide whether alpha blockers should be used or not. All published studies conclude that the only way to reach a decision would be to conduct a randomized study comparing preoperative treatment with alpha blockers to preoperative treatment with placebo, but such a study appears to be impossible to perform as it would need to include thousands of patients with a rate of mortality of surgery of PPGL of 1% (9). Studies based on morbidity might be more feasible, but it would need clinical events as a primary endpoint and it would still require a lot of patients.

Prevention of acute cardiac complications?

It must be kept in mind that the main goal in the management of PPGL is to prevent catecholamine storm, and for this reason, all guidelines recommend surgical resection of a secreting PPGL. We could therefore question whether alpha blockers prevent adrenergic storms. Considering their mode of action, α-adrenergic receptor blockers should reduce the risk of cardiovascular complications during the waiting period prior to surgery (20). To our knowledge, no study has evaluated the benefit of alpha blockers in reducing the risk of acute complications of PPGL, and this would be very difficult to evaluate since most patients will undergo surgery. However, it is generally accepted that patients with metastatic PPGL, in whom surgical removal of all secreting tumors is not possible, should have long-term medical treatment with alpha blockers (21, 22). In addition, several studies have shown that approximately 11% of PPGL patients will experience acute complications, particularly Takotsubo cardiomyopathy (23, 24, 25, 26). In all of these studies reporting acute stress cardiomyopathy, it occurs before the diagnosis of PPGL, even in those patients who have already shown symptoms of catecholamine excess (hypertension, sweating, etc.) (24, 25, 27). The fact that most patients with metastatic PPGL do not develop acute cardiovascular manifestations (28) could be explained by the use of alpha blockers. Additionally, alpha blockade is also useful to protect from the risk of adrenergic storm linked to beta blockers because of unopposed alpha receptor stimulation–adrenergic stimulation (29), in a context where beta blockers are useful for treating tachycardia.

Tolerance of alpha blockers

The potential side effects of alpha blockade have led to questioning of the routine preoperative use of alpha blockade. Indeed, patients may experience side effects, mainly orthostatic hypotension. Moreover, the use of these drugs is likely associated with a higher risk of intraoperative hypotension. These side effects are probably increased by hypovolemia; therefore, it is important to hydrate patients and recommend a high-salt diet before surgery. In some centers, saline solution is infused for 24 h before surgery to decrease the risk of intra- and postoperative hypotension (29). Besides, dosing alpha blockers regarding BP level and dose escalation with a BP target might increase the tolerance of alpha blockers, as shown in the randomized study;no hypotension was reported after surgery, with appropriate perioperative management (18). Other studies have shown that phenoxybenzamine has a longer duration of action and causes more reflex tachycardia when compared to selective alpha blockers (16). However, the potential benefits of alpha blockers in reducing the catastrophic effects of severe intraoperative hypertension and controlling the risk of acute stress cardiomyopathy outweigh the risk of side effects. In addition, the tolerance of alpha blockade is much better, with a lower rate of hypotension, when patients were hydrated prior to commencing alpha blockade.

Conclusions

Even though the current guidelines acknowledge the lack of solid evidence, the potential benefits of alpha blockers, in reducing the catastrophic effects of severe intraoperative hypertension and controlling the risk of acute stress cardiomyopathy, outweigh the risk of side effects. This explains why the guidelines recommend the use of alpha adrenergic receptor blockers in view of the long-standing clinical experience with these drugs, their targeted mode of action, and the various methodological shortcomings of the studies that have suggested that they could be safely omitted.

AGAINST: There is no need for systematic use of a pharmacological treatment

Uncertainty concerning the systematic use of alpha blockers vs other hypertensive drugs is highlighted by one of the sentences in the most recent guidelines on the management of PPGL (4): ‘Even though the evidence underpinning these recommendations for optimal presurgical treatment is almost entirely based on observational studies and expert opinion, the published studies that question this approach do not provide sufficient solid evidence that surgery without appropriate presurgical preparation is safe and feasible’, showing that evidence is lacking from both the pro and con sides of the discussion. Indeed, the available literature lacks a prospective randomized, controlled study comparing alpha blockers vs placebo to ascertain the benefits of alpha blockers. Such a trial would be difficult to perform due to the rarity of the disease, and it would also imply no drug being used to treat hypertension in half of the patients. For this reason, the majority of studies have used a retrospective approach to analyze patient treatment, frequently in a historical perspective, and likely leading to a number of biases. For example, in some studies which included cases from the last 30 years, the decrease in mortality rates observed (from 40 to 0–3%) was ascribed to higher use of alpha blockers (16). However, this conclusion needs to be tempered in view of the major improvements in preoperative characterization of the tumors, as well as improvements in anesthetic and surgical techniques over the same time. Surgery for PPGL is considered high risk due to the possible massive release of catecholamines during intubation and during mobilization of the adrenal mass. Moreover, HDI (usually defined by high > 160 mmHg or low < 60 mmHg blood pressure level peaks and nadirs) is frequently observed during PPGL surgery. However, alpha blockers are not clearly superior to CCB for improving these parameters. Indeed, Brunaudet al.reported that in 155 patients pretreated with either alpha blockers (n = 41) or CCB (n = ), while mean maximal systolic blood pressure was lower with alpha blockers, the number of episodes of low blood pressure was increased with this treatment in comparison to CCB. Interestingly, one-third (n = 54) of patients had HDI, which was irrespective of the preoperative treatment (30). Groeben et al. evaluated hemodynamic conditions and perioperative complications in 276 patients with PPGL, of whom 110 were treated with alpha blockers and 156 with other antihypertensive drugs or no treatment. While no difference in major hemodynamic parameters was observed between the two groups, a 17 mmHg difference in intraoperative maximal systolic blood pressure was observed, being lower in patients receiving alpha blockers. As no major complications occurred after surgery, the authors questioned the systematic use of alpha blockers vs antihypertensive drugs (17). In line with these results, we recently reported a low rate of HDI in 134 patients operated for PPGL in a center with extensive surgical and anesthesiological experience and non-systematic use of alpha blockers (29). Obviously, other publications (31, 32) have reported positive results with systematic use of alpha blockers, but all of these studies, both for and against alpha blockers, had the same methodological limits, these being retrospective series, lack of comparison, and retrospective analysis of patient outcomes.

Side effects of alpha blockers

The most important risk of alpha blocker use is hypotension, sometimes severe, which, per se, is a risk factor of HDI during the surgery, as shown by Bruynzeel et al. (33). In patients with PPGL, it might indeed be associated with more and longer hypertensive episodes during surgery, while immediately after surgery, the risk of alpha blocker use is a persistent alpha adrenergic receptor blockade leading to hypotension and requiring i.v. fluids. In the recent randomized, controlled trial comparing the efficacy of two different alpha receptor blockers, Buitenwerf et al. reported the side effects of these drugs based on 144 patients treated on a systematic basis: 80–92% of patients reported mild to moderate side effects on alpha receptor blockers (including two-thirds who reported at least two different side effects among dizziness, fatigue, headache, or palpitations). Unfortunately, preoperative hypotension was not reported in this study, but roughly 10% of the patients presented with cardiovascular complications despite being on alpha receptor blockers. As a comparison to a group without pretreatment was not performed, it is difficult to determine whether the severity of side effects might have differed in the patients without systematic pretreatment. These data, however, emphasize that alpha blockers should only be used by expert cardiologists/endocrinologists/internists, experienced in managing patients with PPGL (18). Finally, only one recently published study has reported the preliminary results of a monocentric, pilot, open-label, randomized–controlled trial comparing alpha blockers (prazosin, n  = 9) and CCB (amlodipine, n  = 11) in 20 patients presenting with secreting PPGL. Interestingly, in this study, the number of per-operative episodes of hypertension (systolic blood pressure > 160 mmHg) and hypotension (MAP < 60 mmHg) and the per-operative duration of HDI were higher in patients treated with alpha receptor blockers. Currently, CCB are recommended as a second-line treatment in patients on alpha receptor blockers and still presenting with hypertension, or in patients presenting with hypotension on alpha receptor blockers. Their use in patients with mild hypertension is still debated. Though only a limited number of patients were included, the authors concluded that CCB should be considered as an alternative to pre-surgical medical treatment in secreting PPGL (15).

Normotensive patients with PPGL

Is a systematic use of alpha receptor blockers mandatory in normotensive patients with PPGL, a situation reported in 10–40% of patients with PPGL (34, 35, 36). The recent guidelines on the management of PPGL state that ‘Normotensive patients with a PPGL should also receive presurgical medical treatment as they are also at increased risk of HDI’ (4). This is mainly based on the work of Lafont et al., in which the authors reported that HDI was similar between hypertensive patients (n = 24) and normotensive patients (n =10) with PPGL and was more prevalent than in adrenal incidentalomas (n = 16). Interestingly, the majority of patients had been pre-treated with alpha receptor blockers or CCB (19). The authors concluded that patients with this profile required the standard of care for PPGL anesthesia. These results are in contrast with those reported by Shao et al., based on 59 patients, of whom 38 received the alpha blocker doxazosin and 21 did not receive an alpha blocker (no randomization was performed). Intraoperative hemodynamics were not significantly different between the two groups, and preoperative administration of alpha blockers did not improve the peak and nadir blood pressure during tumor resection. In contrast, the group treated with alpha blockers required more vasoactive drugs and colloid infusion. Unfortunately, preoperative catecholamine levels were not provided (14). In such patients, CCB, which inhibit noradrenaline-mediated calcium influx into vascular smooth muscle and present an optimal tolerance profile with a very low risk of hypotension, might be better suited (37). As these results clearly show that ‘silent’ PPGL should not be considered as non-secreting adrenal incidentalomas, their preoperative management should be individualized, weighing the risk of hypertension during surgery, and the risks of prolonged orthostatic postoperative hypotension that may be worsened by alpha blockers.

Prevention of adrenergic storm

Wolf and coworkers defended the systematic use of alpha blockers because of the daily risk to life of catecholamine release in situations of psychological and physical stress (20). To our knowledge, this has never been specifically described in the literature; though it is logical to assume that patients with high levels of norepinephrine (i.e. three to five times above the upper limit of the normal range, leading to tachycardia and hypertension) would be at risk, as shown for peroperative HDI (33). Therefore, in our opinion, this justifies the need for an urgent and thorough examination of cardiac function and blood pressure (including ECG, echocardiography, and 24-h ambulatory blood pressure monitoring), as soon as the diagnosis is raised to determine the need for treatment to be prescribed, including alpha blockers or CCB. Moreover, a list of contra-indicated drugs should be systematically provided to the patient. Such patients should not have postponed surgery (as the time needed to obtain maximal efficacy of alpha blockers would be 7–14 days). To our knowledge, there has not been any report of any adrenergic crisis in normotensive patients with PPGL. In such patients, adding alpha receptor blockers might lead to severe vertigo, malaise, headache, gastrointestinal distress, and hypotension.

Conclusions

Published data are difficult to interpret due to the lack of randomized studies. Additionally, patients with more severe preoperative profiles were more frequently treated using alpha blockers. Moreover, excellent morbidity and mortality results are reported by centers with extensive experience: this might suggest that alpha blockers could be necessary especially in less-experienced centers. While a retrospective study identified the size of the tumor and epinephrine and norepinephrine levels as significant predictors of prolonged hypotension requiring postoperative catecholamine support after surgery (38), another study identified the same parameters as predictors of HDI (39). We thus advocate an individualized medicine approach for presurgical medical treatment, which should consider the cardiological evaluation, the characteristics and comorbidities of the patient and of the PPGL, and the experience of the anesthetist and the surgeon (Fig. 1). Systematic use of alpha blockers as a pre-treatment before surgery should be carefully considered via shared decision-making that includes the cardiologist/endocrinologist/anesthetist on a case-by-case basis. We now propose an algorithm to help decide whether alpha blockers should be considered, based on patient blood pressure and variability, past medical history, and the level of metanephrine (Fig. 1). The key to treatment remains based on preoperative cardiological and anesthetic assessments, short delay to surgery, and peri- and postoperative management of patient hemodynamic status sometimes with catecholamine support; this can only be performed in referral centers with trained physicians, anesthesiologists, and surgeons.

Figure 1
Figure 1

Proposed algorithm for the presurgical treatment of pheochromocytoma and paraganglioma. Hypertension is defined on ambulatory blood pressure measurement, following current guidelines. Elevated blood pressure variability can be assessed on ambulatory blood pressure measurement, for instance above 15 mmHg (40, 41). ULR, upper limit of the normal range; MN, metanephrines; N, upper limit normal value; BP, blood pressure.

Citation: European Journal of Endocrinology 186, 5; 10.1530/EJE-21-0692

Declaration of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this article.

Funding

This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Acknowledgements

The authors would like to thank Dr Vaisse, Dr Silhol, Dr Manceau, Prof. Cholley, Prof Sebag, Dr Paladino, and Prof. Taieb for fruitful weekly discussions on the diagnosis and management of PPGL.

References

  • 1

    Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young Jr WF & Endocrine Society. Pheochromocytoma and paraganglioma: an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism 2014 99 19151942. (https://doi.org/10.1210/jc.2014-1498)

    • Search Google Scholar
    • Export Citation
  • 2

    Luiz HV, Tanchee MJ, Pavlatou MG, Yu R, Nambuba J, Wolf K, Prodanov T, Wesley R, Adams K & Fojo T et al.Are patients with hormonally functional phaeochromocytoma and paraganglioma initially receiving a proper adrenoceptor blockade? A retrospective cohort study. Clinical Endocrinology 2016 85 6269. (https://doi.org/10.1111/cen.13066)

    • Search Google Scholar
    • Export Citation
  • 3

    Sibal L, Jovanovic A, Agarwal SC, Peaston RT, James RA, Lennard TW, Bliss R, Batchelor A, Perros P. Phaeochromocytomas presenting as acute crises after beta blockade therapy. Clinical Endocrinology 2006 65 186190. (https://doi.org/10.1111/j.1365-2265.2006.02571.x)

    • Search Google Scholar
    • Export Citation
  • 4

    Pacak K Preoperative management of the pheochromocytoma patient. Journal of Clinical Endocrinology and Metabolism 2007 92 40694079. (https://doi.org/10.1210/jc.2007-1720)

    • Search Google Scholar
    • Export Citation
  • 5

    Grimson KS, Longino FH. Treatment of a patient with a pheochromocytoma; use of an adrenolytic drug before and during operation. Journal of the American Medical Association 1949 140 1273. (https://doi.org/10.1001/jama.1949.82900510003006a)

    • Search Google Scholar
    • Export Citation
  • 6

    Goldstein RE, O’Neill Jr JA, Holcomb GW 3rd, Morgan WM 3rd, Neblett WW 3rd, Oates JA, Brown N, Nadeau J, Smith B & Page DL et al.Clinical experience over 48 years with pheochromocytoma. Annals of Surgery 1999 229 755764; discussion 6466. (https://doi.org/10.1097/00000658-199906000-00001)

    • Search Google Scholar
    • Export Citation
  • 7

    Lenders JWM, Kerstens MN, Amar L, Prejbisz A, Robledo M, Taieb D, Pacak K, Crona J, Zelinka T & Mannelli M et al.Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. Journal of Hypertension 2020 38 14431456. (https://doi.org/10.1097/HJH.0000000000002438)

    • Search Google Scholar
    • Export Citation
  • 8

    Chen H, Sippel RS, O’Dorisio MS, Vinik AI, Lloyd RV, Pacak K & North American Neuroendocrine Tumor Society (NANETS ). The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 2010 39 775783. (https://doi.org/10.1097/MPA.0b013e3181ebb4f0)

    • Search Google Scholar
    • Export Citation
  • 9

    Groeben H, Walz MK, Nottebaum BJ, Alesina PF, Greenwald A, Schumann R, Hollmann MW, Schwarte L, Behrends M & Rossel T et al.International multicentre review of perioperative management and outcome for catecholamine-producing tumours. British Journal of Surgery 2020 107 e170e178. (https://doi.org/10.1002/bjs.11378)

    • Search Google Scholar
    • Export Citation
  • 10

    Plouin PF, Duclos JM, Soppelsa F, Boublil G, Chatellier G. Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. Journal of Clinical Endocrinology and Metabolism 2001 86 14801486. (https://doi.org/10.1210/jcem.86.4.7392)

    • Search Google Scholar
    • Export Citation
  • 11

    Prys-Roberts C, Farndon JR. Efficacy and safety of doxazosin for perioperative management of patients with pheochromocytoma. World Journal of Surgery 2002 26 10371042. (https://doi.org/10.1007/s00268-002-6667-z)

    • Search Google Scholar
    • Export Citation
  • 12

    Furnica RM, Dusoruth MM, Persu A, Gruson D, Mourad M, Maiter D. Influence of secretory phenotype and preoperative preparation on surgical outcome in pheochromocytoma. Endocrine Connections 2021 10 92101. (https://doi.org/10.1530/EC-20-0537)

    • Search Google Scholar
    • Export Citation
  • 13

    Schimmack S, Kaiser J, Probst P, Kalkum E, Diener MK, Strobel O. Meta-analysis of alpha-blockade versus no blockade before adrenalectomy for phaeochromocytoma. British Journal of Surgery 2020 107 e102e108. (https://doi.org/10.1002/bjs.11348)

    • Search Google Scholar
    • Export Citation
  • 14

    Shao Y, Chen R, Shen ZJ, Teng Y, Huang P, Rui WB, Xie X, Zhou WL. Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary? Journal of Hypertension 2011 29 24292432. (https://doi.org/10.1097/HJH.0b013e32834d24d9)

    • Search Google Scholar
    • Export Citation
  • 15

    Jaiswal SK, Memon SS, Lila A, Sarathi V, Goroshi M, Garg R, Barnabas R, Hemantkumar I, Patel RD & Oak S et al.Preoperative amlodipine is efficacious in preventing intraoperative HDI in pheochromocytoma: pilot RCT. Journal of Clinical Endocrinology and Metabolism 2021 106 e2907–e2918. (https://doi.org/10.1210/clinem/dgab231)

    • Search Google Scholar
    • Export Citation
  • 16

    Berends AMA, Kerstens MN, Lenders JWM, Timmers HJLM. Approach to the patient: perioperative management of the patient with pheochromocytoma or sympathetic paraganglioma. Journal of Clinical Endocrinology and Metabolism 2020 105 30883102. (https://doi.org/10.1210/clinem/dgaa441)

    • Search Google Scholar
    • Export Citation
  • 17

    Groeben H, Nottebaum BJ, Alesina PF, Traut A, Neumann HP, Walz MK. Perioperative alpha-receptor blockade in phaeochromocytoma surgery: an observational case series. British Journal of Anaesthesia 2017 118 182189. (https://doi.org/10.1093/bja/aew392)

    • Search Google Scholar
    • Export Citation
  • 18

    Buitenwerf E, Osinga TE, Timmers HJLM, Lenders JWM, Feelders RA, Eekhoff EMW, Haak HR, Corssmit EPM, Bisschop PHLT & Valk GD et al.Efficacy of alpha-blockers on hemodynamic control during pheochromocytoma resection: a randomized controlled trial. Journal of Clinical Endocrinology and Metabolism 2020 105 23812391. (https://doi.org/10.1210/clinem/dgz188)

    • Search Google Scholar
    • Export Citation
  • 19

    Lafont M, Fagour C, Haissaguerre M, Darancette G, Wagner T, Corcuff JB, Tabarin A. Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas. Journal of Clinical Endocrinology and Metabolism 2015 100 417421. (https://doi.org/10.1210/jc.2014-2998)

    • Search Google Scholar
    • Export Citation
  • 20

    Wolf KI, Santos JRU, Pacak K. Why take the risk? We only live once: the dangers associated with neglecting a pre-operative alpha adrenoceptor blockade in pheochromocytoma patients. Endocrine Practice 2019 25 106108. (https://doi.org/10.4158/EP-2018-0455)

    • Search Google Scholar
    • Export Citation
  • 21

    Jasim S, Jimenez C. Metastatic pheochromocytoma and paraganglioma: management of endocrine manifestations, surgery and ablative procedures, and systemic therapies. Best Practice and Research: Clinical Endocrinology and Metabolism 2020 34 101354. (https://doi.org/10.1016/j.beem.2019.101354)

    • Search Google Scholar
    • Export Citation
  • 22

    Nolting S, Ullrich M, Pietzsch J, Ziegler CG, Eisenhofer G, Grossman A, Pacak K. Current management of pheochromocytoma/paraganglioma: a guide for the practicing clinician in the era of precision medicine. Cancers 2019 11 1505. (https://doi.org/10.3390/cancers11101505)

    • Search Google Scholar
    • Export Citation
  • 23

    Scholten A, Cisco RM, Vriens MR, Cohen JK, Mitmaker EJ, Liu C, Tyrrell JB, Shen WT, Duh QY. Pheochromocytoma crisis is not a surgical emergency. Journal of Clinical Endocrinology and Metabolism 2013 98 581591. (https://doi.org/10.1210/jc.2012-3020)

    • Search Google Scholar
    • Export Citation
  • 24

    Giavarini A, Chedid A, Bobrie G, Plouin PF, Hagege A, Amar L. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart 2013 99 14381444. (https://doi.org/10.1136/heartjnl-2013-304073)

    • Search Google Scholar
    • Export Citation
  • 25

    Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A. Mortality associated with phaeochromocytoma. Hormone and Metabolic Research 2013 45 154158. (https://doi.org/10.1055/s-0032-1331217)

    • Search Google Scholar
    • Export Citation
  • 26

    Gagnon N, Mansour S, Bitton Y, Bourdeau I. Takotsubo-like cardiomyopathy in a large cohort of patients with pheochromocytoma and paraganglioma. Endocrine Practice 2017 23 11781192. (https://doi.org/10.4158/EP171930.OR)

    • Search Google Scholar
    • Export Citation
  • 27

    Batisse-Lignier M, Pereira B, Motreff P, Pierrard R, Burnot C, Vorilhon C, Maqdasy S, Roche B, Desbiez F & Clerfond G et al.Acute and chronic pheochromocytoma-induced cardiomyopathies: different prognoses? A systematic analytical review. Medicine 2015 94 e2198. (https://doi.org/10.1097/MD.0000000000002198)

    • Search Google Scholar
    • Export Citation
  • 28

    Amar L, Baudin E, Burnichon N, Peyrard S, Silvera S, Bertherat J, Bertagna X, Schlumberger M, Jeunemaitre X & Gimenez-Roqueplo AP et al.Succinate dehydrogenase B gene mutations predict survival in patients with malignant pheochromocytomas or paragangliomas. Journal of Clinical Endocrinology and Metabolism 2007 92 38223828. (https://doi.org/10.1210/jc.2007-0709)

    • Search Google Scholar
    • Export Citation
  • 29

    Buisset C, Guerin C, Cungi PJ, Gardette M, Paladino NC, Taieb D, Cuny T, Castinetti F, Sebag F. Pheochromocytoma surgery without systematic preoperative pharmacological preparation: insights from a referral tertiary center experience. Surgical Endoscopy 2021 35 728735. (https://doi.org/10.1007/s00464-020-07439-1)

    • Search Google Scholar
    • Export Citation
  • 30

    Brunaud L, Boutami M, Nguyen-Thi PL, Finnerty B, Germain A, Weryha G, Fahey TJ 3rd, Mirallie E, Bresler L, Zarnegar R. Both preoperative alpha and calcium channel blockade impact intraoperative hemodynamic stability similarly in the management of pheochromocytoma. Surgery 2014 156 14101417; discussion 78. (https://doi.org/10.1016/j.surg.2014.08.022)

    • Search Google Scholar
    • Export Citation
  • 31

    Gosse P, Tauzin-Fin P, Sesay MB, Sautereau A, Ballanger P. Preparation for surgery of phaeochromocytoma by blockade of alpha-adrenergic receptors with urapidil: what dose? Journal of Human Hypertension 2009 23 605609. (https://doi.org/10.1038/jhh.2008.172)

    • Search Google Scholar
    • Export Citation
  • 32

    Kong H, Li N, Li XY, Wang DX. The role of pre-operative alpha-blockade in patients with normotensive phaeochromocytoma or paraganglioma: a retrospective cohort study. European Journal of Anaesthesiology 2018 35 898899. (https://doi.org/10.1097/EJA.0000000000000844)

    • Search Google Scholar
    • Export Citation
  • 33

    Bruynzeel H, Feelders RA, Groenland TH, van den Meiracker AH, van Eijck CH, Lange JF, de Herder WW, Kazemier G. Risk factors for hemodynamic instability during surgery for pheochromocytoma. Journal of Clinical Endocrinology and Metabolism 2010 95 678685. (https://doi.org/10.1210/jc.2009-1051)

    • Search Google Scholar
    • Export Citation
  • 34

    Haissaguerre M, Courel M, Caron P, Denost S, Dubessy C, Gosse P, Appavoupoulle V, Belleannee G, Jullie ML & Montero-Hadjadje M et al.Normotensive incidentally discovered pheochromocytomas display specific biochemical, cellular, and molecular characteristics. Journal of Clinical Endocrinology and Metabolism 2013 98 43464354. (https://doi.org/10.1210/jc.2013-1844)

    • Search Google Scholar
    • Export Citation
  • 35

    Noshiro T, Shimizu K, Watanabe T, Akama H, Shibukawa S, Miura W, Ito S, Miura Y. Changes in clinical features and long-term prognosis in patients with pheochromocytoma. American Journal of Hypertension 2000 13 3543. (https://doi.org/10.1016/s0895-7061(9900139-9)

    • Search Google Scholar
    • Export Citation
  • 36

    Kopetschke R, Slisko M, Kilisli A, Tuschy U, Wallaschofski H, Fassnacht M, Ventz M, Beuschlein F, Reincke M & Reisch N et al.Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. European Journal of Endocrinology 2009 161 355361. (https://doi.org/10.1530/EJE-09-0384)

    • Search Google Scholar
    • Export Citation
  • 37

    Challis BG, Casey RT, Simpson HL, Gurnell M. Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma? Clinical Endocrinology 2017 86 163167. (https://doi.org/10.1111/cen.13252)

    • Search Google Scholar
    • Export Citation
  • 38

    Namekawa T, Utsumi T, Kawamura K, Kamiya N, Imamoto T, Takiguchi T, Hashimoto N, Tanaka T, Naya Y & Suzuki H et al.Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma. Surgery 2016 159 763770. (https://doi.org/10.1016/j.surg.2015.09.016)

    • Search Google Scholar
    • Export Citation
  • 39

    Ma L, Shen L, Zhang X, Huang Y. Predictors of hemodynamic instability in patients with pheochromocytoma and paraganglioma. Journal of Surgical Oncology 2020. (https://doi.org/10.1002/jso.26079)

    • Search Google Scholar
    • Export Citation
  • 40

    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G & Dominiczak A et al.2018 ESC/ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Journal of Hypertension 2018 36 19532041. (https://doi.org/10.1097/HJH.0000000000001940)

    • Search Google Scholar
    • Export Citation
  • 41

    Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nature Reviews: Cardiology 2013 10 143155. (https://doi.org/10.1038/nrcardio.2013.1)

    • Search Google Scholar
    • Export Citation

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 12 12 12
Full Text Views 176 176 176
PDF Downloads 80 80 80
  • View in gallery

    Proposed algorithm for the presurgical treatment of pheochromocytoma and paraganglioma. Hypertension is defined on ambulatory blood pressure measurement, following current guidelines. Elevated blood pressure variability can be assessed on ambulatory blood pressure measurement, for instance above 15 mmHg (40, 41). ULR, upper limit of the normal range; MN, metanephrines; N, upper limit normal value; BP, blood pressure.

  • 1

    Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young Jr WF & Endocrine Society. Pheochromocytoma and paraganglioma: an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism 2014 99 19151942. (https://doi.org/10.1210/jc.2014-1498)

    • Search Google Scholar
    • Export Citation
  • 2

    Luiz HV, Tanchee MJ, Pavlatou MG, Yu R, Nambuba J, Wolf K, Prodanov T, Wesley R, Adams K & Fojo T et al.Are patients with hormonally functional phaeochromocytoma and paraganglioma initially receiving a proper adrenoceptor blockade? A retrospective cohort study. Clinical Endocrinology 2016 85 6269. (https://doi.org/10.1111/cen.13066)

    • Search Google Scholar
    • Export Citation
  • 3

    Sibal L, Jovanovic A, Agarwal SC, Peaston RT, James RA, Lennard TW, Bliss R, Batchelor A, Perros P. Phaeochromocytomas presenting as acute crises after beta blockade therapy. Clinical Endocrinology 2006 65 186190. (https://doi.org/10.1111/j.1365-2265.2006.02571.x)

    • Search Google Scholar
    • Export Citation
  • 4

    Pacak K Preoperative management of the pheochromocytoma patient. Journal of Clinical Endocrinology and Metabolism 2007 92 40694079. (https://doi.org/10.1210/jc.2007-1720)

    • Search Google Scholar
    • Export Citation
  • 5

    Grimson KS, Longino FH. Treatment of a patient with a pheochromocytoma; use of an adrenolytic drug before and during operation. Journal of the American Medical Association 1949 140 1273. (https://doi.org/10.1001/jama.1949.82900510003006a)

    • Search Google Scholar
    • Export Citation
  • 6

    Goldstein RE, O’Neill Jr JA, Holcomb GW 3rd, Morgan WM 3rd, Neblett WW 3rd, Oates JA, Brown N, Nadeau J, Smith B & Page DL et al.Clinical experience over 48 years with pheochromocytoma. Annals of Surgery 1999 229 755764; discussion 6466. (https://doi.org/10.1097/00000658-199906000-00001)

    • Search Google Scholar
    • Export Citation
  • 7

    Lenders JWM, Kerstens MN, Amar L, Prejbisz A, Robledo M, Taieb D, Pacak K, Crona J, Zelinka T & Mannelli M et al.Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. Journal of Hypertension 2020 38 14431456. (https://doi.org/10.1097/HJH.0000000000002438)

    • Search Google Scholar
    • Export Citation
  • 8

    Chen H, Sippel RS, O’Dorisio MS, Vinik AI, Lloyd RV, Pacak K & North American Neuroendocrine Tumor Society (NANETS ). The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas 2010 39 775783. (https://doi.org/10.1097/MPA.0b013e3181ebb4f0)

    • Search Google Scholar
    • Export Citation
  • 9

    Groeben H, Walz MK, Nottebaum BJ, Alesina PF, Greenwald A, Schumann R, Hollmann MW, Schwarte L, Behrends M & Rossel T et al.International multicentre review of perioperative management and outcome for catecholamine-producing tumours. British Journal of Surgery 2020 107 e170e178. (https://doi.org/10.1002/bjs.11378)

    • Search Google Scholar
    • Export Citation
  • 10

    Plouin PF, Duclos JM, Soppelsa F, Boublil G, Chatellier G. Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. Journal of Clinical Endocrinology and Metabolism 2001 86 14801486. (https://doi.org/10.1210/jcem.86.4.7392)

    • Search Google Scholar
    • Export Citation
  • 11

    Prys-Roberts C, Farndon JR. Efficacy and safety of doxazosin for perioperative management of patients with pheochromocytoma. World Journal of Surgery 2002 26 10371042. (https://doi.org/10.1007/s00268-002-6667-z)

    • Search Google Scholar
    • Export Citation
  • 12

    Furnica RM, Dusoruth MM, Persu A, Gruson D, Mourad M, Maiter D. Influence of secretory phenotype and preoperative preparation on surgical outcome in pheochromocytoma. Endocrine Connections 2021 10 92101. (https://doi.org/10.1530/EC-20-0537)

    • Search Google Scholar
    • Export Citation
  • 13

    Schimmack S, Kaiser J, Probst P, Kalkum E, Diener MK, Strobel O. Meta-analysis of alpha-blockade versus no blockade before adrenalectomy for phaeochromocytoma. British Journal of Surgery 2020 107 e102e108. (https://doi.org/10.1002/bjs.11348)

    • Search Google Scholar
    • Export Citation
  • 14

    Shao Y, Chen R, Shen ZJ, Teng Y, Huang P, Rui WB, Xie X, Zhou WL. Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary? Journal of Hypertension 2011 29 24292432. (https://doi.org/10.1097/HJH.0b013e32834d24d9)

    • Search Google Scholar
    • Export Citation
  • 15

    Jaiswal SK, Memon SS, Lila A, Sarathi V, Goroshi M, Garg R, Barnabas R, Hemantkumar I, Patel RD & Oak S et al.Preoperative amlodipine is efficacious in preventing intraoperative HDI in pheochromocytoma: pilot RCT. Journal of Clinical Endocrinology and Metabolism 2021 106 e2907–e2918. (https://doi.org/10.1210/clinem/dgab231)

    • Search Google Scholar
    • Export Citation
  • 16

    Berends AMA, Kerstens MN, Lenders JWM, Timmers HJLM. Approach to the patient: perioperative management of the patient with pheochromocytoma or sympathetic paraganglioma. Journal of Clinical Endocrinology and Metabolism 2020 105 30883102. (https://doi.org/10.1210/clinem/dgaa441)

    • Search Google Scholar
    • Export Citation
  • 17

    Groeben H, Nottebaum BJ, Alesina PF, Traut A, Neumann HP, Walz MK. Perioperative alpha-receptor blockade in phaeochromocytoma surgery: an observational case series. British Journal of Anaesthesia 2017 118 182189. (https://doi.org/10.1093/bja/aew392)

    • Search Google Scholar
    • Export Citation
  • 18

    Buitenwerf E, Osinga TE, Timmers HJLM, Lenders JWM, Feelders RA, Eekhoff EMW, Haak HR, Corssmit EPM, Bisschop PHLT & Valk GD et al.Efficacy of alpha-blockers on hemodynamic control during pheochromocytoma resection: a randomized controlled trial. Journal of Clinical Endocrinology and Metabolism 2020 105 23812391. (https://doi.org/10.1210/clinem/dgz188)

    • Search Google Scholar
    • Export Citation
  • 19

    Lafont M, Fagour C, Haissaguerre M, Darancette G, Wagner T, Corcuff JB, Tabarin A. Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas. Journal of Clinical Endocrinology and Metabolism 2015 100 417421. (https://doi.org/10.1210/jc.2014-2998)

    • Search Google Scholar
    • Export Citation
  • 20

    Wolf KI, Santos JRU, Pacak K. Why take the risk? We only live once: the dangers associated with neglecting a pre-operative alpha adrenoceptor blockade in pheochromocytoma patients. Endocrine Practice 2019 25 106108. (https://doi.org/10.4158/EP-2018-0455)

    • Search Google Scholar
    • Export Citation
  • 21

    Jasim S, Jimenez C. Metastatic pheochromocytoma and paraganglioma: management of endocrine manifestations, surgery and ablative procedures, and systemic therapies. Best Practice and Research: Clinical Endocrinology and Metabolism 2020 34 101354. (https://doi.org/10.1016/j.beem.2019.101354)

    • Search Google Scholar
    • Export Citation
  • 22

    Nolting S, Ullrich M, Pietzsch J, Ziegler CG, Eisenhofer G, Grossman A, Pacak K. Current management of pheochromocytoma/paraganglioma: a guide for the practicing clinician in the era of precision medicine. Cancers 2019 11 1505. (https://doi.org/10.3390/cancers11101505)

    • Search Google Scholar
    • Export Citation
  • 23

    Scholten A, Cisco RM, Vriens MR, Cohen JK, Mitmaker EJ, Liu C, Tyrrell JB, Shen WT, Duh QY. Pheochromocytoma crisis is not a surgical emergency. Journal of Clinical Endocrinology and Metabolism 2013 98 581591. (https://doi.org/10.1210/jc.2012-3020)

    • Search Google Scholar
    • Export Citation
  • 24

    Giavarini A, Chedid A, Bobrie G, Plouin PF, Hagege A, Amar L. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart 2013 99 14381444. (https://doi.org/10.1136/heartjnl-2013-304073)

    • Search Google Scholar
    • Export Citation
  • 25

    Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A. Mortality associated with phaeochromocytoma. Hormone and Metabolic Research 2013 45 154158. (https://doi.org/10.1055/s-0032-1331217)

    • Search Google Scholar
    • Export Citation
  • 26

    Gagnon N, Mansour S, Bitton Y, Bourdeau I. Takotsubo-like cardiomyopathy in a large cohort of patients with pheochromocytoma and paraganglioma. Endocrine Practice 2017 23 11781192. (https://doi.org/10.4158/EP171930.OR)

    • Search Google Scholar
    • Export Citation
  • 27

    Batisse-Lignier M, Pereira B, Motreff P, Pierrard R, Burnot C, Vorilhon C, Maqdasy S, Roche B, Desbiez F & Clerfond G et al.Acute and chronic pheochromocytoma-induced cardiomyopathies: different prognoses? A systematic analytical review. Medicine 2015 94 e2198. (https://doi.org/10.1097/MD.0000000000002198)

    • Search Google Scholar
    • Export Citation
  • 28

    Amar L, Baudin E, Burnichon N, Peyrard S, Silvera S, Bertherat J, Bertagna X, Schlumberger M, Jeunemaitre X & Gimenez-Roqueplo AP et al.Succinate dehydrogenase B gene mutations predict survival in patients with malignant pheochromocytomas or paragangliomas. Journal of Clinical Endocrinology and Metabolism 2007 92 38223828. (https://doi.org/10.1210/jc.2007-0709)

    • Search Google Scholar
    • Export Citation
  • 29

    Buisset C, Guerin C, Cungi PJ, Gardette M, Paladino NC, Taieb D, Cuny T, Castinetti F, Sebag F. Pheochromocytoma surgery without systematic preoperative pharmacological preparation: insights from a referral tertiary center experience. Surgical Endoscopy 2021 35 728735. (https://doi.org/10.1007/s00464-020-07439-1)

    • Search Google Scholar
    • Export Citation
  • 30

    Brunaud L, Boutami M, Nguyen-Thi PL, Finnerty B, Germain A, Weryha G, Fahey TJ 3rd, Mirallie E, Bresler L, Zarnegar R. Both preoperative alpha and calcium channel blockade impact intraoperative hemodynamic stability similarly in the management of pheochromocytoma. Surgery 2014 156 14101417; discussion 78. (https://doi.org/10.1016/j.surg.2014.08.022)

    • Search Google Scholar
    • Export Citation
  • 31

    Gosse P, Tauzin-Fin P, Sesay MB, Sautereau A, Ballanger P. Preparation for surgery of phaeochromocytoma by blockade of alpha-adrenergic receptors with urapidil: what dose? Journal of Human Hypertension 2009 23 605609. (https://doi.org/10.1038/jhh.2008.172)

    • Search Google Scholar
    • Export Citation
  • 32

    Kong H, Li N, Li XY, Wang DX. The role of pre-operative alpha-blockade in patients with normotensive phaeochromocytoma or paraganglioma: a retrospective cohort study. European Journal of Anaesthesiology 2018 35 898899. (https://doi.org/10.1097/EJA.0000000000000844)

    • Search Google Scholar
    • Export Citation
  • 33

    Bruynzeel H, Feelders RA, Groenland TH, van den Meiracker AH, van Eijck CH, Lange JF, de Herder WW, Kazemier G. Risk factors for hemodynamic instability during surgery for pheochromocytoma. Journal of Clinical Endocrinology and Metabolism 2010 95 678685. (https://doi.org/10.1210/jc.2009-1051)

    • Search Google Scholar
    • Export Citation
  • 34

    Haissaguerre M, Courel M, Caron P, Denost S, Dubessy C, Gosse P, Appavoupoulle V, Belleannee G, Jullie ML & Montero-Hadjadje M et al.Normotensive incidentally discovered pheochromocytomas display specific biochemical, cellular, and molecular characteristics. Journal of Clinical Endocrinology and Metabolism 2013 98 43464354. (https://doi.org/10.1210/jc.2013-1844)

    • Search Google Scholar
    • Export Citation
  • 35

    Noshiro T, Shimizu K, Watanabe T, Akama H, Shibukawa S, Miura W, Ito S, Miura Y. Changes in clinical features and long-term prognosis in patients with pheochromocytoma. American Journal of Hypertension 2000 13 3543. (https://doi.org/10.1016/s0895-7061(9900139-9)

    • Search Google Scholar
    • Export Citation
  • 36

    Kopetschke R, Slisko M, Kilisli A, Tuschy U, Wallaschofski H, Fassnacht M, Ventz M, Beuschlein F, Reincke M & Reisch N et al.Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. European Journal of Endocrinology 2009 161 355361. (https://doi.org/10.1530/EJE-09-0384)

    • Search Google Scholar
    • Export Citation
  • 37

    Challis BG, Casey RT, Simpson HL, Gurnell M. Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma? Clinical Endocrinology 2017 86 163167. (https://doi.org/10.1111/cen.13252)

    • Search Google Scholar
    • Export Citation
  • 38

    Namekawa T, Utsumi T, Kawamura K, Kamiya N, Imamoto T, Takiguchi T, Hashimoto N, Tanaka T, Naya Y & Suzuki H et al.Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma. Surgery 2016 159 763770. (https://doi.org/10.1016/j.surg.2015.09.016)

    • Search Google Scholar
    • Export Citation
  • 39

    Ma L, Shen L, Zhang X, Huang Y. Predictors of hemodynamic instability in patients with pheochromocytoma and paraganglioma. Journal of Surgical Oncology 2020. (https://doi.org/10.1002/jso.26079)

    • Search Google Scholar
    • Export Citation
  • 40

    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G & Dominiczak A et al.2018 ESC/ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Journal of Hypertension 2018 36 19532041. (https://doi.org/10.1097/HJH.0000000000001940)

    • Search Google Scholar
    • Export Citation
  • 41

    Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nature Reviews: Cardiology 2013 10 143155. (https://doi.org/10.1038/nrcardio.2013.1)

    • Search Google Scholar
    • Export Citation