Advertisement

Alpha Blocker Versus Calcium Channel Blocker for Pheochromocytoma

  • Elizabeth Holt
  • Jennifer Malinowski
  • Glenda G. Callender
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

The perioperative management of patients undergoing surgical resection of pheochromocytoma is essential to good outcomes. Historically high mortality rates associated with surgery have been mitigated by perioperative management of hemodynamics. Several options exist for the preoperative medical blockade of patients with catecholamine-producing tumors, including non-selective alpha-receptor blockers, selective alpha1-receptor blockers, and calcium channel blockers. In this chapter, we summarize the available data and provide recommendations for the optimal preoperative medical management of patients undergoing surgical resection of pheochromocytoma.

Keywords

Pheochromocytoma Paraganglioma Hemodynamic stability Blood pressure control Alpha blocker Beta blocker Calcium channel blocker 

References

  1. 1.
    Welbourn RB. Early surgical history of phaeochromocytoma. Br J Surg. 1987;74(7):594–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Graham JB. Pheochromocytoma and hypertension; an analysis of 207 cases. Int Abstr Surg. 1951;92(2):105–21.PubMedGoogle Scholar
  3. 3.
    Kvale WF, Manger WM, Priestley JT, Roth GM. Pheochromocytoma. Circulation. 1956;14(4 Part 1):622–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Kinney MA, Warner ME, vanHeerden JA, et al. Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg. 2000;91(5):1118–23.PubMedGoogle Scholar
  5. 5.
    Plouin PF, Duclos JM, Soppelsa F, Boublil G, Chatellier G. Factors associated with perioperative morbidity and mortality in patients with pheochromocytoma: analysis of 165 operations at a single center. J Clin Endocrinol Metab. 2001;86(4):1480–6.PubMedGoogle Scholar
  6. 6.
    Hamilton CA, Reid JL, Sumner DJ. Acute effects of phenoxybenzamine on alpha-adrenoceptor responses in vivo and in vitro: relation of in vivo pressor responses to the number of specific adrenoceptor binding sites. J Cardiovasc Pharmacol. 1983;5:868–73.CrossRefPubMedGoogle Scholar
  7. 7.
    Bravo EL. Pheochromocytoma: an approach to antihypertensive management. Ann N Y Acad Sci. 2002;970:1–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Lehmann HU, Hochrein H, Witt E, Mies HW. Hemodynamic effects of calcium antagonists. Hypertension. 1983;5:1166–73.CrossRefGoogle Scholar
  9. 9.
    Elliott WJ, Ram CV. Calcium channel blockers. J Clin Hypertens. 2011;13:687–9.CrossRefGoogle Scholar
  10. 10.
    Pacak K, Eisenhofer G, Ahlman H, et al. Pheochromocytoma: recommendations for clinical practice from the first international symposium. Nat Clin Pract Endocrinol Metab. 2007;3:92–102.CrossRefPubMedGoogle Scholar
  11. 11.
    Chen H, Sippel RS, Pacak K. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma,paraganglioma & medullary thyroid cancer. Pancreas. 2010;39:775–83.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lenders JWM, Duh Q-Y, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:1915–42.CrossRefPubMedGoogle Scholar
  13. 13.
    Jaeschke R, Guyatt GH, Dellinger P, Schunemann H, Levy MM, Kunz R, Norris S, Bion J. GRADE working group. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:a744.CrossRefPubMedGoogle Scholar
  14. 14.
    Stenström G, Haljamäe H, Tisell LE. Influence of pre-operative treatment with phenoxybenzamine on the incidence of adverse cardiovascular reactions during anaesthesia and surgery for pheochromocytoma. Acta Anaesthesiol Scand. 1985;29:797–803.CrossRefPubMedGoogle Scholar
  15. 15.
    Boutros AR, Bravo EL, Zanettin G, Straffon RA. Perioperative management of 63 patients with pheochromocytoma. Cleve Clin J Med. 1990;57(7):613.CrossRefPubMedGoogle Scholar
  16. 16.
    Steinsapir J, Carr AA, Prisant M, Bransome ED Jr. Metyrosine and pheochromocytoma. Arch Intern Med. 1997;157:901–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC. Successful outcomes in pheochromocytoma surgery in the modern era. J Urol. 1999;161:764–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Shao Y, Chen R, Shen Z, et al. Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary? J Hypertens. 2011;29:2429–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Havlik RJ, Cahow E, Kinder BK. Advances in the diagnosis and treatment of pheochromocytoma. Arch Surg. 1988;123:626–30.CrossRefPubMedGoogle Scholar
  20. 20.
    Russell WJ, Metcalfe IR, Tonkin AL, Frewin DB. The preoperative management of phaeochromocytoma. Anaesth Intensive Care. 1998;26:196–200.PubMedGoogle Scholar
  21. 21.
    Kocak S, Aydintug S, Canakci N. α blockade in preoperative preparation of patients with pheochromocytomas. Int Surg. 2002;87:191–4.PubMedGoogle Scholar
  22. 22.
    Prys-Roberts C, Farndon JR. Efficacy and safety of doxazosin for perioperative management of patients with pheochromocytoma. World J Surg. 2002;26:1037–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Bruynzeel H, Reelders RA, Groenland THN, et al. Risk factors for hemodynamic instability during surgery for pheochromocytoma. J Clin Endocrinol Metab. 2010;95:678–85.CrossRefPubMedGoogle Scholar
  24. 24.
    Weingarden TN, Cata JP, O’Hara JF, et al. Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma. Urology. 2010;76:508e6–11.Google Scholar
  25. 25.
    Zhu Y, He H, Su T, et al. Selective α1-adrenoceptor antagonist (controlled release tablets) in preoperative management of pheochromocytoma. Endocrine. 2010;38:254–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Habbe N, Ruger F, Bojunga J, et al. Urapidil in the preoperative treatment of pheochromocytomas: a safe and cost-effective method. World J Surg. 2013;37:1141–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Agrawal R, Mishra SK, Bhatia E, et al. Prospective study to compare peri-operative hemodynamic alterations following preparation for pheochromocytoma surgery by phenoxybenzamine or prazosin. World J Surg. 2014;38:716–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Kiernan CM, Du L, Chen X, et al. Predictors of hemodynamic instability during surgery for pheochromocytoma. Ann Surg Oncol. 2014;21:3865–71.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Li J, Yang C-H. Improvement of preoperative management in patients with adrenal pheochromocytoma. Int J Clin Exp Med. 2014;7:5541–6.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Proye C, Thevenin D, Cecat P, et al. Exclusive use of calcium channel blockers in preoperative and intraoperative control of pheochromocytomas: hemodynamics and free catecholamine assays in ten consecutive patients. Surgery. 1989;106:1149–54.PubMedGoogle Scholar
  31. 31.
    Lebuffe G, Dosseh ED, Tek G, et al. The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas. Anaesthesia. 2005;60:439–44.CrossRefPubMedGoogle Scholar
  32. 32.
    Siddiqi HD, Yang H, Laird AM, et al. Utility of oral nicardipine and magnesium sulfate infusion during preparation and resection of pheochromocytomas. Surgery. 2012;152:1027–36.CrossRefPubMedGoogle Scholar
  33. 33.
    Brunaud L, Boutami M, Nguyen-Thi P-L, et al. Both preoperative alpha and calcium channel blockade impact intraoperative hemodynamic stability similarly in the management of pheochromocytoma. Surgery. 2014;156:1410–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Elizabeth Holt
    • 1
  • Jennifer Malinowski
    • 2
  • Glenda G. Callender
    • 2
  1. 1.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  2. 2.Department of SurgeryYale University School of MedicineNew HavenUSA

Personalised recommendations