Pheochromocytomas and paragangliomas may secrete catecholamines. Surgical resection of the tumor may be associated with sustained hypertension causing end organ damage. Recognition of patients at risk and suitable pharmacologic preparation can result in reduction in morbidity and mortality.


Pharmacologic management:

(1) alpha-adrenergic receptor blocker (phenoxybenzamine)

(2) beta-adrenergic blocker


Despite pharmacologic premedication many patients developed intraoperative hemodynamic lability. Sustained hypertension (systolic blood pressure > 180 mm Hg for > 10 consecutive minutes) was common.


Risk factors for perioperative adverse effects:

(1) larger tumor

(2) prolonged anesthesia

(3) increased preoperative levels of urinary catecholamines or catecholamine metabolites as measured in 24 hour urine (vanillylmandelic acid, metanephrines, norepinephrine, epinephrine)

(4) while not listed in the paper, it is inferred that failure to treat with alpha and beta adrenergic blockade would be risk factor for adverse effects.



• Trying to come up with numbers that could be used to predict risk is difficult since the data is skewed and there is overlap in the ranges used for comparison.

• Subject to modification, I will use (a) size >= 6.9 cm, (b) anesthesia time >= 4 hours, and (c) urinary VMA > 3.8 * ULN, metanephrine > 6.5 * ULN, norepinephrine > 3.8 * ULN, epinephrine > 10 * ULN


The risk factors tended to be associated with larger tumors (increased size, high urinary excretion of catecholamines) taking longer to resect (longer anesthesia times).


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