title: Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?
abstract: Phaeochromocytomas and paragangliomas (PPGLs) are catecholamine secreting neuroendocrine tumours that predispose to haemodynamic instability. Currently, surgery is the only available curative treatment, but carries potential risks including hypertensive and hypotensive crises, cardiac arrhythmias, myocardial infarction and stroke, due to tumoral release of catecholamines during anaesthetic induction and tumour manipulation. The mortality associated with surgical resection of PPGL has significantly improved from 20-45% in the early 20th century (Apgar & Papper, AMA Archives of Surgery, 1951, 62, 634) to 0-2·9% in the early 21st century (Kinney et al. Journal of Cardiothoracic and Vascular Anesthesia, 2002, 16, 359), largely due to availability of effective pharmacological agents and advances in surgical and anaesthetic practice. However, surgical resection of PPGL still poses significant clinical management challenges. Preoperatively, alpha-adrenoceptor blockade is the mainstay of management, although various pharmacological strategies have been proposed, based largely on reports derived from retrospective data sets. To date, no consensus has been reached regarding the 'ideal' preoperative strategy due, in part, to a paucity of data from high-quality evidence-based studies comparing different treatment regimens. Here, based on the available literature, we address the Clinical Question: Is there an optimal preoperative management strategy for PPGL?
authors.affiliation: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK.|Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: B G
authors.initials: BG
authors.lastname: Challis
authors.affiliation: Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.|Department of Medical Genetics, National Institute for Health Research Biomedical Research Centre, Cambridge, UK.
authors.forename: R T
authors.initials: RT
authors.lastname: Casey
authors.affiliation: Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: H L
authors.initials: HL
authors.lastname: Simpson
authors.affiliation: Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK.|Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gurnell
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D006801:Humans; D010235:Paraganglioma / Q000150:complications / Q000601:surgery / Q000628:therapy*; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods* / Q000592:standards
chemical_list: D000317:Adrenergic alpha-Antagonists