Preoperative preparation for pheochromocytoma resection: physician survey and clinical practice

The objectives of this study are to assess the perceptions of endocrinologists regarding sufficient preoperative preparation for resection of pheochromocytoma (PHEO) and to evaluate how patients with PHEO are actually managed preoperatively. A survey on methods of preoperative preparation was sent to all 39 endocrinologists who had privilege at a large academic hospital. The charts of 43 patients who underwent adrenalectomy for PHEO resection at this hospital between 1997 and 2007 were reviewed. Age, tumor size, blood pressure medications, volume assessment and repletion, duration of preparation, preoperative and intraoperative blood pressures, and length of stay were recorded. Sixteen endocrinologists (41%) returned surveys, with 15 questionnaires completely answered. Seven endocrinologists who saw more PHEOs (5.9 cases per 5 years) indicated they would manage preoperative preparation themselves while 8 endocrinologists who saw 0.4 case per 5 years would refer the care to a subspecialist. Six of the 7 self-managing endocrinologists recognized all important components of preoperative preparation. All 43 patients received appropriate anti-hypertensive medications for PHEO and had blood pressure well controlled preoperatively; however volume status was not addressed in medical records of 65% of patients and only about 50% of patients received preoperative preparation that lasted longer than 1 week. Suboptimal preoperative preparation was associated with longer length of stay but not with intraoperative or postoperative labile blood pressure. We conclude that most endocrinologists possess correct judgment and knowledge on preoperative preparation for PHEO resection. In clinical practice, however, a significant number of patients are not optimally managed preoperatively. Endocrinologists should pay more attention to volume repletion and adequate duration of preparation in clinical practice.