Results From a DELPHI Process
Nicole Bechmann, Costanza Chiapponi, Harald-Thomas Groeben, Christian Grasshoff, Petra Zimmermann, Martin Walz, Martina Mogl, Volker Fendrich, Katharina Holzer, Nada Rayes, Matthias Kroiss, on behalf of the “Section for Adrenal, Steroids and Hypertension” of the German Society of Endocrinology (DGE) and the “Surgical Working Group for Endocrinology” (CAEK) of the German Society for General and Visceral Surgery (DGAV)
Journal of the Endocrine Society, Volume 9, Issue 4, April 2025, bvaf024
https://doi.org/10.1210/jendso/bvaf024
European and German consensus guidelines advocate preoperative therapy with α-adrenoreceptor antagonists in symptomatic patients with catecholamine-producing pheochromocytomas and paragangliomas (PPGLs) to avoid hypertensive crisis during adrenalectomy. This practice has been questioned recently.
This work aimed to assess current preoperative management of PPGLs across disciplines.
The study was conducted from November 2023 to February 2024 using the Delphi technique. Two consecutive surveys were conceived by a steering group and 46 experts were consulted using REDCap web application (response: 74%).
There was general agreement about diagnostic tools and indication for adrenalectomy. In contrast, 20% of the panelists routinely administered α-adrenoreceptor antagonists to all patients, 50% only in case of symptoms, and about one-third of experts abandoned preoperative α-adrenoreceptor blockade. The prevention of anticipated intraoperative hypertensive crisis and cardiovascular complications (75%) as well as medicolegal considerations (25%) were the main motivations. Despite availability of short-acting α-adrenoreceptor antagonists, most experts (63%) continued to use phenoxybenzamine. Half of the experts preferred pretreatment in an outpatient setting, 13% routinely treated in the hospital, and 37% combined outpatient and inpatient treatment. Intraoperatively, urapidil and nitroprusside natrium were mainly used for blood pressure control. Postoperatively, around 60% of the experts routinely admitted patients to an intensive care or intermediate care unit.
Current guideline recommendations for preoperative treatment with α-adrenoreceptor antagonists in patients with PPGLs are generally adopted by treating teams but current practice is very heterogeneous even among expert centers. With the improvement of surgical techniques and intraoperative management, a more individualized approach may be considered.
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