Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?
- 24 October 2016
- journal article
- research article
- Published by Wiley in Clinical Endocrinology
- Vol. 86 (2), 163-167
- https://doi.org/10.1111/cen.13252
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?Keywords
Funding Information
- National Institute for Health Research Cambridge Biomedical Research Centre
This publication has 33 references indexed in Scilit:
- Increased arterial pressure is not predictive of haemodynamic instability in patients undergoing adrenalectomy for phaeochromocytomaActa Anaesthesiologica Scandinavica, 2009
- Management and Treatment of Pheochromocytomas and ParagangliomasAnnals of the New York Academy of Sciences, 2006
- The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomasAnaesthesia, 2005
- Perianesthetic Risks and Outcomes of Pheochromocytoma and Paraganglioma ResectionAnesthesia & Analgesia, 2000
- Postoperative hypertensionCritical Care Medicine, 1992
- Surgical Management of Pheochromocytoma with the Use of MetyrosineAnnals of Surgery, 1990
- A PROSPECTIVE RANDOMIZED TRIAL OF FOUR ANESTHETIC TECHNIQUES FOR RESECTION OF PHEOCHROMOCYTOMAAnesthesiology, 1982
- The Anesthetic Management of PheochromocytomaAnesthesia & Analgesia, 1972
- INHIBITION OF CATECHOLAMINE SYNTHESIS IN MAN WITH ALPHA-METHYL-TYROSINE, AN INHIBITOR OF TYROSINE HYDROXYLASEThe Lancet, 1965