ArticleJournal of the Endocrine Society2025
Preoperative Management of Catecholamine-Producing Pheochromocytomas and Paragangliomas-Results From a DELPHI Process.
Article in Journal of the Endocrine Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Tumor Necrosis is Associated with an Increased Metastatic and Cardiovascular Risk in Paragangliomas: A Single-Center Series and Meta-Analysis Comparing Necrosis and Cystic Degeneration in Paragangliomas.Endocrine pathology · 2026Pooled it
- [Diagnostics and treatment of pheochromocytomas and paragangliomas].Chirurgie (Heidelberg, Germany) · 2026Review
- Pitfalls of Adrenal Washout on CT in the Adult Population: A Pictorial Review.Diagnostics (Basel, Switzerland) · 2026Review
- Predicting Hemodynamic Fluctuations During Adrenalectomy for Pheochromocytoma.Diagnostics (Basel, Switzerland) · 2026Article
- Prolonged alpha-blockade and doxazosin are associated with hypertensive crisis in pheochromocytoma surgery.Frontiers in endocrinology · 2025Article
- Totally Laparoscopic Resection of a Large Retroperitoneal Paraganglioma in an Older Patient: A Case Report on Precise Diagnosis and Perioperative Management.Case reports in gastroenterologyArticle
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Context: European and German consensus guidelines advocate preoperative therapy with α-adrenoreceptor antagonists in symptomatic patients with catecholamine-producing pheochromocytomas and paragangliomas (PPGLs) to avoid hypertensive crisis during adrenalectomy. This practice has been questioned recently. Objective: This work aimed to assess current preoperative management of PPGLs across disciplines. Methods: The study was conducted from November 2023 to February 2024 using the Delphi technique. Two consecutive surveys were conceived by a steering group and 46 experts were consulted using REDCap web application (response: 74%). Results: There was general agreement about diagnostic tools and indication for adrenalectomy. In contrast, 20% of the panelists routinely administered α-adrenoreceptor antagonists to all patients, 50% only in case of symptoms, and about one-third of experts abandoned preoperative α-adrenoreceptor blockade. The prevention of anticipated intraoperative hypertensive crisis and cardiovascular complications (75%) as well as medicolegal considerations (25%) were the main motivations. Despite availability of short-acting α-adrenoreceptor antagonists, most experts (63%) continued to use phenoxybenzamine. Half of the experts preferred pretreatment in an outpatient setting, 13% routinely treated in the hospital, and 37% combined outpatient and inpatient treatment. Intraoperatively, urapidil and nitroprusside natrium were mainly used for blood pressure control. Postoperatively, around 60% of the experts routinely admitted patients to an intensive care or intermediate care unit. Conclusion: Current guideline recommendations for preoperative treatment with α-adrenoreceptor antagonists in patients with PPGLs are generally adopted by treating teams but current practice is very heterogeneous even among expert centers. With the improvement of surgical techniques and intraoperative management, a more individualized approach may be considered.
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