title: 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.
authors.affiliation: Department of Endocrinology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Isaacs
authors.affiliation: Department of Endocrinology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.|St Vincent's Hospital and Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Lee
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D010235:Paraganglioma / Q000188:drug therapy / Q000601:surgery; D010673:Pheochromocytoma / Q000188:drug therapy / Q000601:surgery; D057285:Precision Medicine / Q000191:economics / Q000379:methods; D011300:Preoperative Care / Q000379:methods
chemical_list: D000317:Adrenergic alpha-Antagonists