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Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach

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Abstract

Objective

To offer a practical guide for the presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas (PGLs).

Methods

This protocol was based on a comprehensive review of the literature and on our own multidisciplinary team’s experience from managing pheochromocytoma and sympathetic PGLs at a referral center.

Results

Patients with pheochromocytomas and sympathetic paragangliomas (PGLs) may develop potentially life-threatening complications, especially during surgical procedures. A complete biochemical, radiological, genetic, and cardiological assessment is recommended in the preoperative stage as it provides an evaluation of the risk of surgical complications and malignancy, allowing individualization of the presurgical treatment. Treatment with α-blockade and proper volume expansion in the preoperative stage significantly reduces the perioperative morbidity. During surgery, the anesthesiologist should look for a deep anesthetic level that inhibits the cardiovascular effects of catecholamines to minimize the risk of intraoperative complications.

Conclusions

An optimal presurgical evaluation of pheochromocytomas/ sympathetic PGL requires a multidisciplinary approach, including a complete hormonal, radiological, cardiac, genetic, and functioning evaluation in most cases. A proper preoperative evaluation in combination with strict blood pressure and heart rate control, and blood volume status optimization, will significantly reduce the risk of intraoperative and perioperative complications. In those patients who unfortunately develop intraoperative complications, the role of the anesthesiologist is essential since the selection of the appropriate management has a direct impact on morbimortality reduction.

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Acknowledgements

Committee of endocrine tumors of the Hospital Ramón y Cajal. Madrid. Spain

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Authors and Affiliations

  1. Neuroendocrinology Division, Department of Endocrinology and Nutrition, IRYCIS, Hospital Universitario Ramón y Cajal, Colmenar Viejo street, S/N, 28034, Madrid, Spain

    M. Araujo-Castro, E. Pascual-Corrales & L. Nattero Chavez

  2. Department of Nuclear Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain

    A. Martínez Lorca

  3. Department of Medical Oncology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain

    T. Alonso-Gordoa & J. Molina-Cerrillo

  4. Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain

    J. Lorca Álvaro, C. Mínguez Ojeda & V. Gómez Dos Santos

  5. Department of Vascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    S. Redondo López

  6. Department of Otorhinolaryngology, Hospital Universitario Ramón y Cajal, Madrid, Spain

    R. Barberá Durbán & R. Polo López

  7. Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    N. Moreno Mata & U. Caballero Silva

  8. Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain

    H. Pian & I. Ruz-Caracuel

  9. Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    A. Sanjuanbenito Dehesa

  10. Department of Anesthesia, Hospital Universitario Ramón y Cajal, Madrid, Spain

    A. B. Serrano Romero

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  1. M. Araujo-Castro
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  2. E. Pascual-Corrales
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  17. V. Gómez Dos Santos
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  18. A. B. Serrano Romero
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Correspondence to M. Araujo-Castro.

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This article was elaborated by the multidisciplinary adrenal/paraganglioma team of the Hospital Ramón y Cajal. Madrid (Spain).

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Araujo-Castro, M., Pascual-Corrales, E., Nattero Chavez, L. et al. Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach. J Endocrinol Invest 44, 2545–2555 (2021). https://doi.org/10.1007/s40618-021-01649-7

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  • DOI: https://doi.org/10.1007/s40618-021-01649-7

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