嗜铬细胞瘤
医学
副神经节瘤
血压
术前护理
重症监护医学
外科
内科学
作者
Frederic Castinetti,Jean-Baptiste De Freminville,Carole Guerin,Erika Cornu,Gabrielle Sarlon,Laurence Amar
出处
期刊:European journal of endocrinology
[Bioscientifica]
日期:2022-03-01
卷期号:186 (5): D17-D24
被引量:3
摘要
The question of systematic use of a pharmacological treatment before surgery in patients diagnosed with pheochromocytoma and paraganglioma (PPGL) remains highly controversial. While recent guidelines suggest that this should be used in all patients, some experienced teams consider it unnecessary in some cases, provided the surgery is performed in a dedicated center that has expert endocrinologists, cardiologists, surgeons, and anesthetists. This controversy is aimed at shedding light on the potential benefits and risks of such a treatment, focusing specifically on alpha blockers which are considered as the first-line medical treatments in patients with PPGL. After discussing the rationale for alpha blockers, hemodynamic instability, tolerance, and acute cardiac complications will then be discussed in the first part of the manuscript, defending a systematic use. The second section will focus on blood pressure control, tolerance of alpha blockers, and also the management of normotensive PPGL, examining the daily risks of PPGL and arguing against the systematic use of a preoperative pharmacological treatment before surgery. Finally, we will discuss the concept of expert centers and define the patients in whom the risk/benefit profile would favor the use of this preoperative treatment.
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