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Preoperative alpha-blockade in phaeochromocytoma and paraganglioma: is it always necessary?

Abstract

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 PPGLs presenting with hypertension, it is less clear whether alpha-blockade is necessary in predominantly dopamine-secreting tumours, normotensive PPGLs, as well as tumours that appear to be biochemically 'silent'. Preoperative management of these 'atypical' PPGLs 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.

Type Journal
ISBN 1365-2265 (Electronic) 0300-0664 (Linking)
Authors Isaacs, M.; Lee, P.
Publisher Name CLIN ENDOCRINOL
Published Date 2017-03-01 00:00:00
Published Volume 86
Published Issue 3
Published Pages 309-314
URL http://www.ncbi.nlm.nih.gov/pubmed/27864838 http://onlinelibrary.wiley.com/store/10.1111/cen.13284/asset/cen13284.pdf?v=1&t=j25lz2er&s=4b92bfcdb8865591a45581c5233322d5fc8a47e7
Status Published in-print