Kiernan et al identified factors associated with hemodynamic instability during surgical resection of a pheochromocytoma. These can help to identify a patient who may benefit from closer monitoring and more aggressive management. The authors are from Vanderbilt University in Nashville.


Patient selection: surgical resection of pheochromocytoma


Hemodynamic instability involved one or more of the following:

(1) systolic blood pressure > 200 mm Hg (hypertensive)

(2) systolic blood pressure > 130% of baseline (hypertensive)

(3) systolic blood pressure < 70% of baseline (hypotensive)

(4) heart rate > 110 beats per minute (tachycardia)


A patient may experience hemodynamic instability while the tumor is manipulated even if normotensive prior to surgery.


Factors associated with increased hemodynamic instability:

(1) large tumors

(2) open adrenalectomy (versus laparoscopic)

(3) use of selective alpha blockade (with doxazosin, prazosin or terazosin) rather non-selective alpha blockade (with phenoxybenzamine)



• Open surgery tended to be done for larger tumors, bilateral tumors, resection of adjacent organs, tumor invasion of inferior vena cava, reoperation, or an attempt to spare the adrenal cortex.

• The postoperative outcomes were similar for the two blockade types.


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