Prolonged alpha-blockade and doxazosin are associated with hypertensive crisis in pheochromocytoma surgery

Hypertensive crisis represents a significant intraoperative challenge in pheochromocytoma surgery, often necessitating immediate pharmacologic intervention. To reduce this risk, preoperative α-adrenergic blockade is routinely implemented. Although prior studies have addressed the choice of α-blockade, the impact of its type, treatment duration, and final titrated dose on hypertensive crisis has not yet been established.

A retrospective analysis was conducted on 110 patients undergoing laparoscopic adrenalectomy for pheochromocytoma. The type of alpha-blocker (doxazosin: DOX vs. phenoxybenzamine: PXB), duration of preoperative preparation, and final titrated dose were evaluated regarding their impact on the risk and duration of intraoperative hypertensive crisis (SBP >200 mmHg).

The duration of hypertensive crisis was significantly longer in the DOX group (median 15.0 (10.0-30.0) vs. 10.0 (5.0-15.0 min, p=0.03). The DOX group demonstrated higher intraoperative vasopressor use (39.6% vs. 10.9%, p<0.001), and a longer perioperative hospitalization compared to the PXB group (median 3.0 (2.2-4.0) vs 2.0 (2.0-3.0), p<0.001). Diabetes, urinary metanephrines >10× ULN, and preoperative α-blockade >30 days were independent risk factors for hypertensive crisis. Prolonged blockade was linked to longer crisis duration and increased vasopressor use, particularly with DOX. The final α-blocker dose did not influence hypertensive outcomes.

Selective α-blockade with doxazosin resulted in longer hypertensive crises, increased intraoperative vasopressor requirements, and prolonged hospitalization. Prolonged α-blockade (>30 days) was associated with more frequent and prolonged hypertensive crises and a higher risk of postoperative vasopressor use.