Current Preoperative Preparation of Pheochromocytoma/Paraganglioma Syndrome

Daniel P Goldstein, Marcia R Voigt and Daniel Ruan

Department of Surgery, Wake Forest School of Medicine, 475 Vine Street, Bowman Gray Center for Medical Education, Winston-Salem, NC 27101, USA
Department of Surgery, Tampa General Hospital, 1 Tampa General Cir, Tampa, FL 33606, USA

^*Correspondance to: Daniel Ruan 

 PDF  Full Text DOI: 10.25107/2474-1647.1517

Abstract

Pheochromocytomas and paragangliomas are catecholamine-producing neoplasms that can cause life-threatening hemodynamic instability, particularly intraoperatively, when the tumor is manipulated. Preoperative medical management reduces both preoperative morbidity and mortality. The current review discusses the latest literature on preoperative management. Preoperative strategies include a nonselective alpha-antagonist, selective alpha antagonists, calcium channel blockers, tyrosine hydroxylase inhibitors, and fluid and salt loading. Compared to selective alpha-antagonists, preparation with phenoxybenzamine prior to surgery is associated with superior intraoperative hemodynamic stability, but also more post-operative hypotension, adverse drug effects, and longer treatment period. No studies indicate a difference in clinical outcomes between phenoxybenzamine and selective alpha-antagonists. Calcium channel inhibitors have been shown in multiple studies to have similar hemodynamic stability and outcomes as patients with pre-operative alpha blockades, particularly in patients with smaller tumors. Metyrosine has been shown to attenuate intraoperative hemodynamic stability when used in conjugation with phenoxybenzamine or a selective alpha-antagonist. Magnesium-sulfate does not improve intraoperative hemodynamic instability when used in conjuction with nicardipine. Therefore multiple effective strategies exist to prevent morbidity and mortality associated with resection, however, a lack of preparation is not one of them.

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Cite the article

Goldstein DP, Voigt MR, Ruan D. Current Preoperative Preparation of Pheochromocytoma/Paraganglioma Syndrome. Clin Surg. 2017; 2: 1517.