Perioperative management of pheocromocytoma/ paraganglioma: a comprehensive review

  • Alejandro Román-González a. School of Medicine, Universidad de Antioquia. Medellín, Colombia. b. San Vicente Fundación University Hospital. Medellín, Colombia. https://orcid.org/0000-0001-5942-1035
  • Huber Padilla-Zambrano Center for Biomedical Research (CIB), School of Medicine, Universidad de Cartagena. Cartagena Colombia. https://orcid.org/0000-0003-4523-0646
  • Luis Felipe Vásquez Jimenez Pablo Tobón Uribe Hospital. Medellín, Antioquia.
Keywords: Pheochromocytoma, Preoperative care, Intraoperative care, Drug therapy, Postoperative care

Abstract

Pheochromocytomas are rare neuroendocrine neoplasms that require adequate preoperative evaluation in order to prevent and lessen the serious complications of catecholamine hypersecretion. Preoperative management contributes to reducing morbidity and mortality rates in patients who have not been diagnosed with this condition and undergo any surgery. However, current mortality seems to be lower, a fact attributed to preoperative management with alpha blockers.

References

Erlic Z, Beuschlein F. Metabolic Alterations in Patients with Pheochromocytoma. Exp Clin Endocrinol Diabetes. 2019;127(02/03):129–36. doi: https://doi.org/10.1055/a-0649-0960

Turchini J, Cheung VKY, Tischler AS, De Krijger RR, Gill AJ. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology. 2018;72(1):97–105. doi: https://doi.org/10.1111/his.13402

Farrugia F, Martikos G, Tzanetis P, Charalampopoulos A, Misiakos E, Zavras N, et al. Pheochromocytoma, diagnosis and treatment: Review of the literature. Endocr Regul. 2017;51(3):168–81. doi: https://doi.org/10.1515/enr-2017-0018

Tsirlin A, Oo Y, Sharma R, Kansara A, Gliwa A, Banerji MA. Pheochromocytoma: A review. Maturitas. 2014;77(3):229–38. doi: https://doi.org/10.1016/j.maturitas.2013.12.009

Mercado-Asis LB, Wolf KI, Jochmanova I, Taïeb D. Pheochromocytoma: a genetic and diagnostic update. Endocr Pract. 2018;24(1):78–90. doi: https://doi.org/10.4158/EP-2017-0057

Davison AS, Jones DM, Ruthven S, Helliwell T, Shore SL. Clinical evaluation and treatment of phaeochromocytoma. Ann Clin Biochem Int J Lab Med. 2018;55(1):34–48. doi: https://doi.org/10.1177/0004563217739931

Kimura N, Takekoshi K, Naruse M. Risk Stratification on Pheochromocytoma and Paraganglioma from Laboratory and Clinical Medicine. J Clin Med. 2018;7(9):242. doi: https://doi.org/10.3390/jcm7090242

Kiernan CM, Solorzano C. Phaeochromocytoma and Paraganglioma: Diagnosis, Genetics, and Treatment. In: Surg Oncol Clin N Am. Elsevier Inc; 2016. p. 119–138. doi: https://doi.org/10.1016/j.soc.2015.08.006

Fishbein L. Pheochromocytoma and Paraganglioma: Genetics, Diagnosis, and Treatment. Hematol Oncol Clin North Am. 2016;30(1):135–50. doi: https://doi.org/10.1016/j.hoc.2015.09.006

Thosani S, Ayala-Ramirez M, Román-González A, Zhou S, Thosani N, Bisanz A, et al. Constipation: an overlooked, unmanaged symptom of patients with pheochromocytoma and sympathetic paraganglioma. Eur J Endocrinol. 2015;173(3):377–87. doi: https://doi.org/10.1530/EJE-15-0456

Gunawardane PTK, Grossman A. Phaeochromocytoma and Paraganglioma. In: Adv Exp Med Biol. 2016. p. 239–59. doi: https://doi.org/10.1007/5584_2016_76

Zhou W, Ding SF. Concurrent Pheochromocytoma, Ventricular Tachycardia, Left Ventricular Thrombus, and Systemic Embolization. Intern Med. 2009;48(12):1015–9. doi: https://doi.org/10.2169/internalmedicine.48.2022

Edafe O, Webster J, Fernando M, Vinayagam R, Balasubramanian SP. Phaeochromocytoma with hypercortisolism and hypercalcaemia. BMJ Case Rep. 2015;2015. doi: https://doi.org/10.1136/bcr-2014-208657

Jain A, Baracco R, Kapur G. Pheochromocytoma and paraganglioma—an update on diagnosis, evaluation, and management. Pediatr Nephrol. 2019; doi: https://doi.org/10.1007/s00467-018-4181-2

Lenders JWM, Eisenhofer G. Update on Modern Management of Pheochromocytoma and Paraganglioma. Endocrinol Metab. 2017;32(2):152. doi: https://doi.org/10.3803/EnM.2017.32.2.152

Neumann HPH, Young WF, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med. 2019;381:552–65. doi: https://doi.org/10.1056/NEJMra1806651

Fishbein L, Orlowski R, Cohen D. Pheochromocytoma/Paraganglioma: Review of Perioperative Management of Blood Pressure and Update on Genetic Mutations Associated With Pheochromocytoma. J Clin Hypertens. 2013;15(6):428–34. doi: https://doi.org/10.1111/jch.12084

Naranjo J, Dodd S, Martin YN. Perioperative Management of Pheochromocytoma. J Cardiothorac Vasc Anesth. 2017;31(4):1427–39. doi: https://doi.org/10.1053/j.jvca.2017.02.023

Ahmed A. Perioperative management of pheochromocytoma: Anaesthetic implications. J Pak Med Assoc. 2007;57(3):140–6.

Schreiner F, Anand G, Beuschlein F. Perioperative Management of Endocrine Active Adrenal Tumors. Exp Clin Endocrinol Diabetes. 2019;127(02/03):137–46. doi: https://doi.org/10.1055/a-0654-5251

Connor D, Boumphrey S. Perioperative care of phaeochromocytoma. BJA Educ. 2016;16(5):153–8. doi: https://doi.org/10.1093/bjaed/mkv033

Pacak K. Preoperative Management of the Pheochromocytoma Patient. J Clin Endocrinol Metab. 2007;92(11):4069–79. doi: https://doi.org/10.1210/jc.2007-1720

Kerstens MN, Wolffenbuttel BHR. Preoperative pharmacological management of phaeochromocytoma. J Med. 2006;64(8):290–5.

Lentschener C, Gaujoux S, Tesniere A, Dousset B. Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal? Eur J Endocrinol. 2011;165(3):365–73. doi: https://doi.org/10.1530/EJE-11-0162

Ramachandran R, Rewari V. Current perioperative management of pheochromocytomas. Indian J Urol. 2016;(1):19–25. doi: https://doi.org/10.4103/0970-1591.194781.

Groeben H, Walz MK, Nottebaum BJ, Alesina PF, Greenwald A, Schumann R, et al. International multicentre review of perioperative management and outcome for catecholamine-producing tumours. Br J Surg. 2020;107(2):e170–8. doi: https://doi.org/10.1002/bjs.11378

Goldstein DP, Voigt MR, Ruan D. Current Preoperative Preparation of Pheochromocytoma /Paraganglioma Syndrome. Clin Surg - Endocr Surg. 2017;2:1–5.

Martucci VL, Pacak K. Pheochromocytoma and paraganglioma: diagnosis, genetics, management, and treatment. Curr Probl Cancer. 2014/01/15. 2014;38(1):7–41. doi: https://doi.org/10.1016/j.currproblcancer.2014.01.001

Schimmack S, Kaiser J, Probst P, Kalkum E, Diener MK, Strobel O. Meta-analysis of alpha-blockade versus no blockade before adrenalectomy for phaeochromocytoma. Br J Surg. 2020;107(2):e102–8. doi: https://doi.org/10.1002/bjs.11348

Santos JRU, Wolf KI, Pacak K. A necessity, not a second thought: pre-operative alpha-adrenoceptor blockade in pheochromocytoma patients. Endocr Pract. 2019;25(2):200–1. doi: https://doi.org/10.4158/1934-2403-25.2.200

Lentschener C, Baillard C, Dousset B, Gaujoux S. Dogma is made to be broken. why are we postponing curative surgery to administer ineffective alpha adrenoreceptor blockade in most patients undergoing pheochromocytoma removal? Endocr Pract. 2019;25(2):199. doi: https://doi.org/10.4158/1934-2403-25.2.199

Isaacs M, Lee P. Preoperative alpha-blockade in phaeochromocytoma and paraganglioma: is it always necessary? Clin Endocrinol (Oxf). 2017;86(3):309–14. doi: https://doi.org/10.1111/cen.13284

Doenicke A, Soukup J, Hoernecke R, Moss J. The Lack of Histamine Release with Cisatracurium: A Double-Blind Comparison with Vecuronium. Anesth Analg. 1997;84(3):623–8. doi: https://doi.org/10.1097/00000539-199703000-00030

Roizen M, Schreider B, Hassan S. Anesthesia for patients with pheochromocytoma. Anesth Clin North Am. 1987;5:269–75.

Scholten A, Cisco RM, Vriens MR, Cohen JK, Mitmaker EJ, Liu C, et al. Pheochromocytoma crisis is not a surgical emergency. J Clin Endocrinol Metab. 2013;98(2):581–91. doi: https://doi.org/10.1210/jc.2012-3020

Salinas CL, Gómez Beltran OD, Sánchez-Hidalgo JM, Bru RC, Padillo FJ, Rufián S. Emergency adrenalectomy due to acute heart failure secondary to complicated pheochromocytoma: a case report. World J Surg Oncol. 2011;9:49. doi: https://doi.org/10.1186/1477-7819-9-49

Jiang M, Ding H, Liang Y, Tang J, Lin Y, Xiang K, et al. Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients. Clin Endocrinol (Oxf). 2018;88(3):498–505. doi: https://doi.org/10.1111/cen.13544

Bruynzeel H, Feelders RA, Groenland THN, van den Meiracker AH, van Eijck CHJ, Lange JF, et al. Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma. J Clin Endocrinol Metab. 2010;95(2):678–85. doi: https://doi.org/10.1210/jc.2009-1051

Lafont M, Fagour C, Haissaguerre M, Darancette G, Wagner T, Corcuff JB, et al. Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas. J Clin Endocrinol Metab. 2015;100(2):417–21. doi: https://doi.org/10.1210/jc.2014-2998

Gu YW, Poste J, Kunal M, Schwarcz M, Weiss I. Cardiovascular Manifestations of Pheochromocytoma. Cardiol Rev. 2017;25(5):215–22. doi: https://doi.org/10.1097/CRD.0000000000000141

Lenders JWM, Duh Q-Y, Eisenhofer G, Gimenez-Roqueplo A-P, Grebe SKG, Murad MH, et al. Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(6):1915–42. doi: https://doi.org/10.1210/jc.2014-1498

Shen WT, Sturgeon C, Clark OH, Duh Q-Y, Kebebew E. Should pheochromocytoma size influence surgical approach? A comparison of 90 malignant and 60 benign pheochromocytomas. Surgery. 2004;136(6):1129–37. doi: https://doi.org/10.1016/j.surg.2004.05.058

Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A, et al. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013;11(2):152–6. doi: https://doi.org/10.1016/j.ijsu.2012.12.007

Kulis T, Knezevic N, Pekez M, Kastelan D, Grkovic M, Kastelan Z. Laparoscopic adrenalectomy: lessons learned from 306 cases. J Laparoendosc Adv Surg Tech A. 2012;22(1):22–6. doi: https://doi.org/10.1089/lap.2011.0376

Lorenz K, Langer P, Niederle B, Alesina P, Holzer K, Nies C, et al. Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbeck’s Arch Surg. 2019;404(4):385–401. doi: https://doi.org/10.1007/s00423-019-01768-z

Gumbs AA, Gagner M. Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab. 2006;20(3):483–99. doi: https://doi.org/10.1016/j.beem.2006.07.010.

Callender GG, Kennamer DL, Grubbs EG, Lee JE, Evans DB, Perrier ND. Posterior retroperitoneoscopic adrenalectomy. Adv Surg. 2009;43:147–57. doi: https://doi.org/10.1016/j.yasu.2009.02.017

Prys-Roberts C. Phaeochromocytoma--recent progress in its management. Br J Anaesth. 2000;85(1):44–57. doi: https://doi.org/10.1093/bja/85.1.44

Pinaud M, Desjars P, Cozian A, Nicolas F. [Fluid loading in the surgical care of pheochromocytoma. Hemodynamic study]. Ann Fr Anesth Reanim. 1982;1(1):53–8. doi: https://doi.org/10.1016/s0750-7658(82)80076-2

De Backer D, Bakker J, Cecconi M, Hajjar L, Liu DW, Lobo S, et al. Alternatives to the Swan-Ganz catheter. Intensive Care Med. 2018;44(6):730–41. doi: https://doi.org/10.1007/s00134-018-5187-8

Niederle MB, Fleischmann E, Kabon B, Niederle B. The determination of real fluid requirements in laparoscopic resection of pheochromocytoma using minimally invasive hemodynamic monitoring: a prospectively designed trial. Surg Endosc. 2020;34(1):368–76. doi: https://doi.org/10.1007/s00464-019-06777-z

Matsuura T, Kashimoto S, Okuyama K, Oguchi T, Kumazawa T. [Anesthesia with transesophageal echocardiography for removal of pheochromocytoma]. Masui. 1995;44(10):1388–90.

Matsuda Y, Kawate H, Shimada S, Matsuzaki C, Nagata H, Adachi M, et al. Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS). Endocr J. 2014;61:571–5. doi: https://doi.org/10.1507/endocrj.ej13-0471

Burns JM, Sing RF, Mostafa G, Huynh TT, Jacobs DG, Miles WS, et al. The role of transesophageal echocardiography in optimizing resuscitation in acutely injured patients. J Trauma. 2005;59(1):32–6. doi: https://doi.org/10.1097/01.ta.0000171460.56972.42

Kanchi M, Nair HC, Banakal S, Murthy K, Murugesan C. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy. Indian J Anaesth. 2011;55(3):260–5. doi: https://doi.org/10.4103/0019-5049.82673

Maze M, Smith CM. Identification of receptor mechanism mediating epinephrine-induced arrhythmias during halothane anesthesia in the dog. Anesthesiology. 1983;59(4):322–6. doi: https://doi.org/10.1097/00000542-198310000-00009

Lippmann M, Ford M, Lee C, Ginsburg R, Foran W, Raum W, et al. Use of desflurane during resection of phaeochromocytoma. Br J Anaesth. 1994;72:707–9. doi: https://doi.org/10.1093/bja/72.6.707

Janeczko GF, Ivankovich AD, Glisson SN, Heyman HJ, El-Etr AA, Albrecht RF. Enflurane anesthesia for surgical removal of pheochromocytoma. Anesth Analg. 1977;56(1):62–7. doi: https://doi.org/10.1213/00000539-197701000-00016

Kinney MA, Warner ME, vanHeerden JA, Horlocker TT, Young WFJ, Schroeder DR, et al. Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg. 2000;91(5):1118–23. doi: https://doi.org/10.1097/00000539-200011000-00013

Castillo OA, Vitagliano G, Olivares R, Soffia P, Contreras M. Laparoscopic Resection of an Extra-adrenal Pheochromocytoma. Surg Laparosc Endosc Percutaneous Tech. 2007;17(4):351–3. doi: https://doi.org/10.1097/SLE.0b013e318059b9d4

Jung J-W, Park JK, Jeon SY, Kim YH, Nam S-H, Choi Y-G, et al. Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma -A case report-. Korean J Anesthesiol. 2012;63(6):555–8. doi: https://doi.org/10.4097/kjae.2012.63.6.555

Naguib M, Samarkandi AH, Bakhamees HS, Magboul MA, el-Bakry AK. Histamine-release haemodynamic changes produced by rocuronium, vecuronium, mivacurium, atracurium and tubocurarine. Br J Anaesth. 1995;75(5):588–92. doi: https://doi.org/10.1093/bja/75.5.588

Amaranath L, Zanettin GG, Bravo EL, Barnes A, Estafanous FG. Atracurium and pheochromocytoma: a report of three cases. Anesth Analg. 1988;67(11):1127–30.

Solares G, Ramos F, Blanco J, Blanco E. Alcuronium, pancuronium and phaeochromocytoma. Vol. 42, Anaesthesia. England; 1987. p. 77–8. doi: https://doi.org/10.1111/j.1365-2044.1987.tb02951.x

Stoner TRJ, Urbach KF. Cardiac arrhythmias associated with succinylcholine in a patient with pheochromocytoma. Anesthesiology. 1968;29(6):1228–9. doi: https://doi.org/10.1097/00000542-196811000-00025

Ahmad I, El-Boghdadly K, Bhagrath R, Hodzovic I, McNarry AF, Mir F, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia. 2020;75(4):509–28. doi: https://doi.org/10.1111/anae.14904

Breslin DS, Farling PA, Mirakhur RK. The use of remifentanil in the anaesthetic management of patients undergoing adrenalectomy: a report of three cases. Anaesthesia. 2003;58(4):358–62. doi: https://doi.org/10.1046/j.1365-2044.2003.03080.x

Leonard JB, Munir KM, Kim HK. Metoclopramide induced pheochromocytoma crisis. Am J Emerg Med. 2018;36(6):1124.e1-1124.e2. doi: https://doi.org/10.1016/j.ajem.2018.03.009

Nizamoglu A, Salihoglu Z, Bolayrl M. Effects of epidural-and-general anesthesia combined versus general anesthesia during laparoscopic adrenalectomy. Surg Laparosc Endosc Percutan Tech. 2011;21(5):372–9. doi: https://doi.org/10.1097/SLE.0b013e31822dd5e1.

Jayatilaka G, Abayadeera A, Wijayaratna C, Senanayake H, Wijayaratna M. Phaeochromocytoma during pregnancy: anaesthetic management for a caesarean section combined with bilateral adrenalectomy. Ceylon Med J. 2013;58(4):173–4. doi: https://doi.org/10.4038/cmj.v58i4.6310

Lipson A, Hsu T-H, Sherwin B, Geelhoed GW. Nitroprusside Therapy for a Patient With a Pheochromocytoma. JAMA. 1978;239(5):427–8. doi: https://doi.org/10.1001/jama.1978.03280320043018

Zakowski M, Kaufman B, Berguson P, Tissot M, Yarmush L, Turndorf H. Esmolol use during resection of pheochromocytoma: report of three cases. Anesthesiology. 1989;70(5):875–7. doi: https://doi.org/10.1097/00000542-198905000-00030

James MF, Cronjé L. Pheochromocytoma Crisis: The Use of Magnesium Sulfate. Anesth Analg. 2004;99(3). doi: https://doi.org/10.1213/01.ANE.0000133136.01381.52

Erdoğan MA, Uçar M, Özkan AS, Özgül Ü, Durmuş M. Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma. Vol. 44, Turkish Journal of Anaesthesiology and Reanimation. 2016. p. 47–9. doi: https://doi.org/10.5152/TJAR.2016.25993

Ramakrishna H. Pheochromocytoma resection: Current concepts in anesthetic management. J Anaesthesiol Clin Pharmacol. 2015;31(3):317. doi: https://doi.org/10.4103/0970-9185.161665

Namekawa T, Utsumi T, Kawamura K, Kamiya N, Imamoto T, Takiguchi T, et al. Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma. Surgery. 2016;159(3):763–70. doi: https://doi.org/10.1016/j.surg.2015.09.016

Hua J, Chen G, Li H, Fu S, Zhang L-M, Scott M, et al. Intensive intraoperative insulin therapy versus conventional insulin therapy during cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth. 2012;26(5):829–34. doi: https://doi.org/10.1053/j.jvca.2011.12.016

Duggan EW, Carlson K, Umpierrez GE. Perioperative Hyperglycemia Management: An Update. Anesthesiology. 2017;126(3):547–60. doi: https://doi.org/10.1097/ALN.0000000000001515

Domi R, Sula H. Pheochromocytoma, the Challenge to Anesthesiologists. J Endocrinol Metab. 2011;1(3):97–100. doi: https://doi.org/10.4021/jem27w

Garg M, Brar K, Mittal R, Kharb S, Gundgurthi A. Medical management of pheochromocytoma: Role of the endocrinologist. Indian J Endocrinol Metab. 2011;15(8):329. doi: https://doi.org/10.4103/2230-8210.86976

Bajwa S, Bajwa S. Implications and considerations during pheochromocytoma resection: A challenge to the anesthesiologist. Indian J Endocrinol Metab. 2011;15(8):337. doi: https://doi.org/10.4103/2230-8210.86977

How to Cite
1.
Román-González A, Padilla-Zambrano H, Vásquez Jimenez LF. Perioperative management of pheocromocytoma/ paraganglioma: a comprehensive review. Colomb. J. Anesthesiol. [Internet]. 2020Dec.4 [cited 2021Jul.28];49(3). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/958

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2020-12-04
How to Cite
1.
Román-González A, Padilla-Zambrano H, Vásquez Jimenez LF. Perioperative management of pheocromocytoma/ paraganglioma: a comprehensive review. Colomb. J. Anesthesiol. [Internet]. 2020Dec.4 [cited 2021Jul.28];49(3). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/958
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