{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:30:42Z","timestamp":1787502642822,"version":"build-2736575974"},"reference-count":29,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["314061271\u2014TRR205"],"award-info":[{"award-number":["314061271\u2014TRR205"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>European and German consensus guidelines advocate preoperative therapy with \u03b1-adrenoreceptor antagonists in symptomatic patients with catecholamine-producing pheochromocytomas and paragangliomas (PPGLs) to avoid hypertensive crisis during adrenalectomy. This practice has been questioned recently.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This work aimed to assess current preoperative management of PPGLs across disciplines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was general agreement about diagnostic tools and indication for adrenalectomy. In contrast, 20% of the panelists routinely administered \u03b1-adrenoreceptor antagonists to all patients, 50% only in case of symptoms, and about one-third of experts abandoned preoperative \u03b1-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 \u03b1-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current guideline recommendations for preoperative treatment with \u03b1-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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jendso\/bvaf024","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T15:22:43Z","timestamp":1739287363000},"source":"Crossref","is-referenced-by-count":11,"title":["Preoperative Management of Catecholamine-Producing Pheochromocytomas and Paragangliomas\u2014Results From a DELPHI Process"],"prefix":"10.1210","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6932-333X","authenticated-orcid":false,"given":"Nicole","family":"Bechmann","sequence":"first","affiliation":[{"name":"Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universit\u00e4t Dresden , Dresden 01307 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costanza","family":"Chiapponi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine , Munich 81675 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald-Thomas","family":"Groeben","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte , Essen 45136 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0716-2171","authenticated-orcid":false,"given":"Christian","family":"Grasshoff","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, T\u00fcbingen University Hospital , T\u00fcbingen 72076 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich , Munich 80336 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Walz","sequence":"additional","affiliation":[{"name":"Department of Surgery and Minimally Invasive Surgery, Kliniken Essen-Mitte , Essen 45136 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Mogl","sequence":"additional","affiliation":[{"name":"Department of Surgery, Campus Charit\u00e9 Mitte, Campus Virchow-Klinikum, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Berlin 10117 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Fendrich","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sch\u00f6n Klinik Hamburg Eilbek , Hamburg 22081 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Holzer","sequence":"additional","affiliation":[{"name":"Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg , Marburg 35043 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Rayes","sequence":"additional","affiliation":[{"name":"Department of Visceral-, Transplant-, Thoracic and Vascular Surgery, University Hospital of Leipzig , Leipzig 04103 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Kroiss","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, University Hospital Munich , Munich 80336 ,","place":["Germany"]},{"name":"Kroiss Endokrinologie und Diabetologie , Schweinfurt 97422 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"issue":"1","key":"2025031003172442700_bvaf024-B1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12022-022-09704-6","article-title":"Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas","volume":"33","author":"Mete","year":"2022","journal-title":"Endocr Pathol"},{"issue":"11","key":"2025031003172442700_bvaf024-B2","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/HJH.0b013e32834a4ce9","article-title":"Cardiovascular manifestations of phaeochromocytoma","volume":"29","author":"Prejbisz","year":"2011","journal-title":"J Hypertens"},{"issue":"1","key":"2025031003172442700_bvaf024-B3","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the study of adrenal tumors","volume":"189","author":"Fassnacht","year":"2023","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2025031003172442700_bvaf024-B4","first-page":"637","article-title":"A survey on adrenal incidentaloma in Italy","volume":"85","author":"Mantero","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2025031003172442700_bvaf024-B5","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1530\/EJE-09-0384","article-title":"Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma","volume":"161","author":"Kopetschke","year":"2009","journal-title":"Eur J Endocrinol"},{"issue":"10","key":"2025031003172442700_bvaf024-B6","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/BF03346680","article-title":"Clinically silent chromaffin-cell tumors: tumor characteristics and long-term prognosis in patients with incidentally discovered pheochromocytomas","volume":"33","author":"Grozinsky-Glasberg","year":"2010","journal-title":"J Endocrinol Invest"},{"issue":"11","key":"2025031003172442700_bvaf024-B7","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1530\/EC-18-0318","article-title":"Missed clinical clues in patients with pheochromocytoma\/paraganglioma discovered by imaging","volume":"7","author":"Rogowski-Lehmann","year":"2018","journal-title":"Endocr Connect"},{"issue":"6","key":"2025031003172442700_bvaf024-B8","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1210\/jc.2014-1498","article-title":"Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2025031003172442700_bvaf024-B9","doi-asserted-by":"crossref","first-page":"1127676","DOI":"10.3389\/fendo.2023.1127676","article-title":"Total versus partial adrenalectomy in bilateral pheochromocytoma\u2013a systematic review and meta-analysis","volume":"14","author":"Zawadzka","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"3","key":"2025031003172442700_bvaf024-B10","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/ejendo\/lvae108","article-title":"PRAP study\u2014partial versus radical adrenalectomy in hereditary pheochromocytomas","volume":"191","author":"Xu","year":"2024","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"2025031003172442700_bvaf024-B11","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00423-019-01768-z","article-title":"Surgical therapy of adrenal tumors: guidelines from the German association of endocrine surgeons (CAEK)","volume":"404","author":"Lorenz","year":"2019","journal-title":"Langenbecks Arch Surg"},{"issue":"2","key":"2025031003172442700_bvaf024-B12","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1002\/bjs.11348","article-title":"Meta-analysis of \u03b1-blockade versus no blockade before adrenalectomy for phaeochromocytoma","volume":"107","author":"Schimmack","year":"2020","journal-title":"Journal of British Surgery"},{"issue":"5","key":"2025031003172442700_bvaf024-B13","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1097\/JS9.0000000000000390","article-title":"Preoperative \u03b1-blockade versus no blockade for pheochromocytoma\u2013paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis","volume":"109","author":"Wang","year":"2023","journal-title":"Int J Surg"},{"issue":"4","key":"2025031003172442700_bvaf024-B14","first-page":"190","article-title":"Pheochromocytoma: a review on preoperative treatment with phenoxybenzamine or doxazosin","volume":"72","author":"Van der Zee","year":"2014","journal-title":"Neth J Med"},{"issue":"5","key":"2025031003172442700_bvaf024-B15","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s00268-013-1933-9","article-title":"Urapidil in the preoperative treatment of pheochromocytomas: a safe and cost-effective method","volume":"37","author":"Habbe","year":"2013","journal-title":"World J Surg"},{"issue":"1","key":"2025031003172442700_bvaf024-B16","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4103\/joacp.JOACP_71_18","article-title":"Peri-operative management of pheochromocytoma with intravenous urapidil to prevent hemodynamic instability: a 17-year experience","volume":"36","author":"Tauzin-Fin","year":"2020","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"2","key":"2025031003172442700_bvaf024-B17","doi-asserted-by":"crossref","first-page":"e170","DOI":"10.1002\/bjs.11378","article-title":"International multicentre review of perioperative management and outcome for catecholamine-producing tumours","volume":"107","author":"Groeben","year":"2020","journal-title":"Br J Surg"},{"issue":"2","key":"2025031003172442700_bvaf024-B18","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/bja\/aew392","article-title":"Perioperative \u03b1-receptor blockade in phaeochromocytoma surgery: an observational case series","volume":"118","author":"Groeben","year":"2017","journal-title":"Br J Anaesth"},{"issue":"2","key":"2025031003172442700_bvaf024-B19","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2025031003172442700_bvaf024-B20","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"2","key":"2025031003172442700_bvaf024-B21","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1210\/jc.2009-1051","article-title":"Risk factors for hemodynamic instability during surgery for pheochromocytoma","volume":"95","author":"Bruynzeel","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"2025031003172442700_bvaf024-B22","volume-title":"Intraoperative Hemodynamic Instability During Laparoscopic Adrenalectomy for Pheochromocytoma Without Preoperative Medical Preparation Versus Non-Secreting Tumor","author":"Nomine-Criqui","year":"2024"},{"issue":"12","key":"2025031003172442700_bvaf024-B23","doi-asserted-by":"crossref","first-page":"3865","DOI":"10.1245\/s10434-014-3847-7","article-title":"Predictors of hemodynamic instability during surgery for pheochromocytoma","volume":"21","author":"Kiernan","year":"2014","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"2025031003172442700_bvaf024-B24","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.surg.2017.05.029","article-title":"Hemodynamic instability during surgery for pheochromocytoma: comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients","volume":"163","author":"Vorselaars","year":"2018","journal-title":"Surgery"},{"issue":"1","key":"2025031003172442700_bvaf024-B25","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1530\/EJE-11-0148","article-title":"Hemodynamic instability during resection of pheochromocytoma in MEN versus non-MEN patients","volume":"165","author":"Scholten","year":"2011","journal-title":"Eur J Endocrinol"},{"issue":"10","key":"2025031003172442700_bvaf024-B26","doi-asserted-by":"crossref","first-page":"3295","DOI":"10.1210\/clinem\/dgaa502","article-title":"Sino-European differences in the genetic landscape and clinical presentation of pheochromocytoma and paraganglioma","volume":"105","author":"Jiang","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2025031003172442700_bvaf024-B27","doi-asserted-by":"crossref","first-page":"bvae038","DOI":"10.1210\/jendso\/bvae038","article-title":"Patient sex and origin influence distribution of driver genes and clinical presentation of paraganglioma","volume":"8","author":"Richter","year":"2024","journal-title":"J Endocr Soc"},{"issue":"1","key":"2025031003172442700_bvaf024-B28","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1097\/JS9.0000000000001995","article-title":"Genetic background and intraoperative haemodynamic instability in patients with pheochromocytoma and paraganglioma: a multicenter retrospective study","volume":"111","author":"Li","year":"2024","journal-title":"Int J Surg"},{"issue":"5","key":"2025031003172442700_bvaf024-B29","doi-asserted-by":"crossref","first-page":"594","DOI":"10.3390\/cancers11050594","article-title":"Impact of extrinsic and intrinsic hypoxia on catecholamine biosynthesis in absence or presence of HIF2\u03b1 in pheochromocytoma cells","volume":"11","author":"Bechmann","year":"2019","journal-title":"Cancers (Basel)"}],"container-title":["Journal of the Endocrine Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jes\/advance-article-pdf\/doi\/10.1210\/jendso\/bvaf024\/61900312\/bvaf024.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/9\/4\/bvaf024\/61900312\/bvaf024.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/9\/4\/bvaf024\/61900312\/bvaf024.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,9]],"date-time":"2025-03-09T23:17:42Z","timestamp":1741562262000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jes\/article\/doi\/10.1210\/jendso\/bvaf024\/8015717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,3]]}},"URL":"https:\/\/doi.org\/10.1210\/jendso\/bvaf024","relation":{},"ISSN":["2472-1972"],"issn-type":[{"value":"2472-1972","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,2,14]]},"article-number":"bvaf024"}}