Endocrine Abstracts

Introduction: There is variation in practice with regards to preoperative optimization protocols and postoperative management in pheocromocytoma and related paraganglioma (PPGL). We aimed to review the literature on perioperative strategies to reduce morbidity and mortality following surgery for PPGL and enhance understanding of optimal approaches.

Methods: Two databases were systematically searched in January 2020 for terms related to perioperative management of PPGL. Articles were screened and included if they described preoperative strategies, intraoperative manoeuvres or interventions and postoperative regimens, both pharmacological and non-pharmacological.

Results: The initial search identified 625 articles, of which 89 studies met the inclusion criteria, including 5387 patients, of which 91% were observational, and 21% evaluated the impact of preoperative interventions by including a control group; 48% were published in the last decade. Alpha-blockade was mentioned in 90% of studies: phenoxybenzamine (66%), doxazosin (26%), prazosin (26%). 40% of studies mentioned either use of preoperative high fluid intake, intravenous fluids and/or high-sodium diet. Eleven studies reported hypoglycemia episodes, which occurred mainly in the first 24 hours after surgery, but ranged between 60 min and 162 hours after surgery. Postoperative vasopressors were usually used for sustained hypotension which was not corrected by intravenous saline replacement. In 11 studies, only 14.6% of 895 patients required postoperative vasopressors for sustained hypotension.

Conclusions: The variation of practices described in this paper underlines the lack of consensus on the optimal strategy in practices of perioperative management of pheocromocytoma. These practices are based largely on local experiences and retrospective studies with the inherent biases they carry thus resulting in poor strength of recommendations in current guidelines.