Background: A pheochromocytoma is a rare neuroendocrine tumor, originating from adrenomedullary chromaffin cells. The pre-surgical management of pheochromocytoma is classically performed with alpha-blockers. However, in some cases other pharmacological approaches can be considered.
Objective: The aim of the study is to describe the clinical course of patients with pheochromocytoma prepared for surgery with calcium channel blockers (CCB).
Methods: We collected clinical data from patients with pheochromocytoma submitted to surgery in our institution who were prepared with CCB, from 2012 to 2020.
Results: In our institution, 5 patients with pheochromocytoma, 3 males and 2 females, were prepared to laparoscopic surgery with CCB. The ages at diagnosis ranged from 43 to 76 years-old. The mean plasmatic normetanephrine was 989 pg/ml (RR<196) and metanephrine 632,4 pg/ml (RR<65). Arterial hypertension was controlled with nifedipine (60-90 mg/day) in four patients and with amlodipine (5 mg/day) in one patient. During the surgery, three patients needed sodium nitroprusside and a short acting beta-blocker during the tumor manipulation, showing recovery. One patient presented arterial hypotension after tumor removal that solved with phenylephrine. No other intercurrences were registered. Three patients were discharged in 2 days, one patient in 4 days, and the longer hospitalization lasted 8 days due to a respiratory infection.
Conclusions: We can consider that patients with pheochromocytoma can be submitted to a successful surgery without preoperative profound and long-lasting alpha adrenergic blockade. According to literature, alpha blockers are associated to orthostatic hypotension, reflex tachycardia and refractory hypotension after tumor removal. Thus, calcium channel blockers might be a safe alternative in pre-surgical management, with less adverse effects, being easy to titrate and without the need of hospitalization before surgery for hemodynamic stabilization.