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Pheochromocytoma Preoperative Preparation

Medical preparation to balance catecholamine effects before pheochromocytoma surgery.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Pheochromocytoma Preoperative Preparation?

Pheochromocytoma preoperative preparation is the medical stabilization process designed to prevent hypertensive crises and arrhythmias caused by sudden catecholamine (adrenaline, noradrenaline) release during tumor manipulation in surgery.

Preparation is generally applied for 7-14 days before surgery. The basic principle is alpha-adrenergic blockade first (phenoxybenzamine or doxazosin), then beta-adrenergic blockade if needed. Beta-blockade should never be started without alpha-blockade because alpha-2 receptor stimulation leads to paradoxical hypertension.

During preparation, a high-salt diet (5-6 g/day) and abundant fluid intake are needed to fill the vascular bed contracted by long-standing vasoconstriction. Calcium channel blockers, alpha-methylparatyrosine and magnesium can also be used as alternative/adjunct therapies. Preoperative goals: systolic BP <160/90 mmHg, allowing orthostatic hypotension and pulse 60-80 beats/min.

Symptoms

Paroxysmal hypertension
Triad of sweating, palpitations and headache
High plasma/urine catecholamines
Adrenal/paraganglioma mass on imaging
MIBG or DOTATATE PET positivity
Cushing, MEN2 or VHL associated conditions
Patient with confirmed pheochromocytoma diagnosis

Risk Factors

Inadequate preoperative preparation (hypertensive crisis risk)
Large tumor size (>5 cm)
Extra-adrenal pheochromocytoma (paraganglioma)
Multiple endocrine neoplasia (MEN2)
Von Hippel-Lindau syndrome
Succinate dehydrogenase mutations
Cardiovascular comorbidities

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • High catecholamine and metanephrine results
  • Adrenal mass on imaging
  • Hypertensive crisis attacks
  • Consultation before surgical planning
  • Multidisciplinary tumor board
  • Endocrine-surgery-anesthesia coordination

Treatment Methods

01
Initiation of alpha-blockade with phenoxybenzamine or doxazosin (7-14 days before)
02
Stepwise dose escalation (starting with phenoxybenzamine 10 mg/day)
03
High-salt diet (5-6 g/day) and hydration
04
Addition of beta-blockade (after sufficient alpha-blockade)
05
Orthostatic hypotension and pulse monitoring
06
Preoperative ECG and echocardiography
07
Multidisciplinary planning with anesthesia team

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.