Differences in α-Blockade Practices Between Endocrine and Surgical Specialties for Pheochromocytoma and Paraganglioma...

Surgery remains the only definitive cure for pheochromocytoma and paraganglioma. The impact of variable α-blockade practices preoperatively has not been explored. This study compared preoperative α-blockade strategies between endocrine and surgical specialties and assessed their differences in perioperative outcomes.

This retrospective longitudinal cohort study included patients with pheochromocytoma and paraganglioma who underwent laparoscopic or robot-assisted surgical resection between 2006 and 2023 at a single academic center.

The cohort comprised 78 patients (endocrine group [n = 28] and surgical group [n = 50]). There were no significant differences in baseline hormonal profiles or tumor size between the groups. Both groups more commonly used selective α-blockers over nonselective agents. Patients in the endocrine group underwent a shorter course of α-blockade (median [IQR]: 17 days [14-39] vs 27 days [17-55]), received higher doses of selective (mean ± SD: 10 mg ± 8.6 vs 6.9 mg ± 4.3) and nonselective α-blockers (60 mg ± 32 vs 35 mg ± 14.5), and had a higher frequency of daily α-blocker administration compared to the surgical group. Despite these variations in practice, perioperative hemodynamic outcomes remained comparable between groups. Across the overall cohort, larger tumor size and higher metanephrine concentrations were associated with both systolic and diastolic hypotension (P < .05 for both). Elevated metanephrine levels and older age correlated with prolonged duration of systolic blood pressure >160 mmHg (P < .05).

Despite differences in α-blockade strategies between the groups, perioperative hemodynamic outcomes were comparable, supporting flexibility in management. Tumor burden and patient age were associated with perioperative hemodynamic variability.