Preoperative treatment and survival of patients with pheochromocytomas

Operative treatment is the method of choice for pheochromocytomas. The best success of the operation requires both good operative technique and effective preoperative medication. Phenoxybenzamine hydrochloride, an alpha-receptor blocker, has been our traditional premedication. Since 1988 we have used it in a combination with alpha-methylthyrosine, a catecholamine-synthesis blocker.

To evaluate different preoperative medications.

Between 1984 and 1994 22 patients were operated on for pheochromocytomas in Tampere University Hospital. Five patients received alpha-receptor blocker, three patients received catecholamine-synthesis blocker, and 14 patients received their combination for a median of 33 days prior to the operation.

Three of the five patients receiving alpha-receptor blocker, two of the three patients receiving catecholamine-synthesis blocker, and four of the 14 patients receiving combination therapy demonstrated high systolic blood pressure during the operation. Three patients, one in the alpha-receptor blocker group and two in the combination therapy group, demonstrated a short hypotensive period during the operation. None of the patients experienced severe perioperative cardiac arrhythmias. Mild sedation occurred similarly in either premedications, but the treatment did not need to be discontinued due to adverse reactions. There was no hospital mortality. Two patients had postoperative complications.

Our initial experience with the combination therapy with alpha-receptor blocker and catecholamine-synthesis blocker is encouraging.