{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:01:28Z","timestamp":1792422088349,"version":"4.5.0"},"reference-count":22,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":87,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Preoperative alpha blockade is recommended for phaeochromocytomas and paragangliomas (PPGLs), whereas evidence for calcium channel blockers remains limited. This study evaluated perioperative haemodynamic outcomes with first-line amlodipine for preoperative blockade and identified predictors of intraoperative haemodynamic instability (iHDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\/design<\/jats:title>\n                    <jats:p>In this monocentric retrospective study, 35 operated PPGL patients who received preoperative first-line amlodipine (July 2021\u2013March 2024) were analysed. Continuous intraoperative arterial pressure recordings were analysed for episodes and duration of hypertension, hypotension, and iHDI. Biochemical phenotype and tumour characteristics were assessed as predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort (median age: 32 years; 60% female) included 32 phaeochromocytomas and 3 sympathetic paragangliomas. Germline variants were detected in 20\/34 tested patients (cluster 1: 11; cluster 2: 9). Amlodipine up to 20 mg was tolerated in all except two, with a median of 7 days to reach BP targets. Median iHDI duration was 6.67% (0\u201316.4). On linear regression, log-transformed plasma free metanephrine (PFMN) independently predicted iHDI duration (\u03b2 = 2.26, P = 0.027). Patients with adrenergic phenotype (n = 13) exhibited a longer duration of SBP \u2265 160 mmHg (14 vs 1 min), a higher peak SBP (201 vs 160 mmHg), and a higher nitroglycerine dose (659 vs 59.6 \u03bcg) than those with noradrenergic phenotype. Postoperative hypotension (37.1%) was associated with a higher plasma free normetanephrine level (3,440 vs 1,242.9 ng\/L) and a larger tumour size (5.1 vs 4.2 cm). No perioperative mortality occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>First-line amlodipine blockade was effective in preventing iHDI in PPGLs. Plasma free metanephrine and normetanephrine correlated with intraoperative hypertension and postoperative hypotension, respectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-25-0921","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:53:35Z","timestamp":1774281215000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative first-line amlodipine in phaeochromocytoma\/paraganglioma: perioperative haemodynamic instability and its predictors"],"prefix":"10.1530","volume":"15","author":[{"given":"Chandramouli","family":"L","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba Samad","family":"Memon","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9623-4471","authenticated-orcid":true,"given":"Anurag Ranjan","family":"Lila","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjiri","family":"Karlekar","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Phadte","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijaya","family":"Sarathi","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7612-506X","authenticated-orcid":true,"given":"Rohit","family":"Barnabas","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sailaja Pramod","family":"Bijani","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Rege","sequence":"additional","affiliation":[{"name":"4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh Prabhakar","family":"Takalkar","sequence":"additional","affiliation":[{"name":"4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amala","family":"Kudalkar","sequence":"additional","affiliation":[{"name":"5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarti","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini","family":"Shah","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6902-4639","authenticated-orcid":true,"given":"Tushar R","family":"Bandgar","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"2026070714055584200_bib1","doi-asserted-by":"crossref","first-page":"4069","DOI":"10.1210\/jc.2007-1720","article-title":"Preoperative management of the pheochromocytoma patient","volume":"92","author":"Pacak","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070714055584200_bib2","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/cen.13544","article-title":"Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients","volume":"88","author":"Jiang","year":"2018","journal-title":"Clin Endocrinol"},{"key":"2026070714055584200_bib3","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":"2026070714055584200_bib4","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1016\/j.surg.2014.08.022","article-title":"Both preoperative alpha and calcium channel blockade impact intraoperative haemodynamic stability similarly in the management of pheochromocytoma","volume":"156","author":"Brunaud","year":"2014","journal-title":"Surgery"},{"key":"2026070714055584200_bib5","doi-asserted-by":"crossref","first-page":"e2907","DOI":"10.1210\/clinem\/dgab231","article-title":"Preoperative amlodipine is efficacious in preventing intraoperative HDI in pheochromocytoma: pilot RCT","volume":"106","author":"Jaiswal","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070714055584200_bib6","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1210\/clinem\/dgz188","article-title":"Efficacy of \u03b1-blockers on haemodynamic control during pheochromocytoma resection: a randomised controlled trial","volume":"105","author":"Buitenwerf","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070714055584200_bib7","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1210\/endrev\/bnad011","article-title":"Biochemical assessment of pheochromocytoma and paraganglioma","volume":"44","author":"Eisenhofer","year":"2023","journal-title":"Endocr Rev"},{"key":"2026070714055584200_bib8","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/jch.12571","article-title":"Treatment of hypertension in children with catecholamine-secreting tumours: a systematic approach","volume":"17","author":"Romero","year":"2015","journal-title":"J Clin Hypertens"},{"key":"2026070714055584200_bib9","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/EJA.0000000000000941","article-title":"The haemodynamic instability score: development and internal validation of a new rating method of intra-operative haemodynamic in stability","volume":"36","author":"Buitenwerf","year":"2019","journal-title":"Eur J Anaesthesiol"},{"key":"2026070714055584200_bib10","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1111\/j.1399-6576.1998.tb05387.x","article-title":"Haemodynamic heterogeneity and treatment with the calcium channel blocker nicardipine during phaeochromocytoma sur gery","volume":"42","author":"Colson","year":"1998","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026070714055584200_bib11","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1365-2044.2005.04156.x","article-title":"The effect of calcium channel blockers on outcome following the surgical treatment of phaeochromocytomas and paragangliomas","volume":"60","author":"Lebuffe","year":"2005","journal-title":"Anaesthesia"},{"key":"2026070714055584200_bib12","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1056\/NEJMc1817267","article-title":"Ivabradine in catecholamine-induced tachycardia in a patient with paraganglioma","volume":"380","author":"Malaza","year":"2019","journal-title":"N Engl J Med"},{"key":"2026070714055584200_bib13","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/cen.14557","article-title":"Risk factors for haemodynamic instability and its prolongation during laparoscopic adrenalectomy for pheochromocytoma","volume":"95","author":"Takeda","year":"2021","journal-title":"Clin Endocrinol"},{"key":"2026070714055584200_bib14","doi-asserted-by":"crossref","first-page":"2843","DOI":"10.1002\/jcsm.13071","article-title":"Impact of body composition and genotype on haemodynamics during surgery for pheochromocytoma and paraganglioma","volume":"13","author":"Pang","year":"2022","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"2026070714055584200_bib15","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 multicentre retrospective study","volume":"111","author":"Li","year":"2025","journal-title":"Int J Surg"},{"key":"2026070714055584200_bib16","doi-asserted-by":"crossref","first-page":"3865","DOI":"10.1245\/s10434-014-3847-7","article-title":"Predictors of haemodynamic instability during surgery for pheochromocytoma","volume":"21","author":"Kiernan","year":"2014","journal-title":"Ann Surg Oncol"},{"key":"2026070714055584200_bib17","doi-asserted-by":"crossref","first-page":"729","DOI":"10.21037\/gs.2019.11.22","article-title":"Incidence, risk factors and clinical significance of postoperative haemodynamic instability after adrenalectomy for phaeochromocytoma","volume":"8","author":"Thompson","year":"2019","journal-title":"Gland Surg"},{"key":"2026070714055584200_bib18","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1177\/000313481808400642","article-title":"Predictive factors of operative haemodynamic instability for pheochromocytoma","volume":"84","author":"Aksakal","year":"2018","journal-title":"Am Surgeon TM"},{"key":"2026070714055584200_bib19","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1530\/EC-20-0537","article-title":"Influence of secretory phenotype and preoperative preparation on surgical outcome in pheochromocytoma","volume":"10","author":"Furnica","year":"2021","journal-title":"Endocr Connections"},{"key":"2026070714055584200_bib20","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.urology.2016.10.012","article-title":"Preoperative levels of catecholamines and metanephrines and intraoperative haemodynamics of patients undergoing pheochromocytoma and paraganglioma resection","volume":"100","author":"Weingarten","year":"2017","journal-title":"Urology"},{"key":"2026070714055584200_bib21","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.surg.2015.09.016","article-title":"Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma","volume":"159","author":"Namekawa","year":"2016","journal-title":"Surgery"},{"key":"2026070714055584200_bib22","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1007\/s00464-015-4294-7","article-title":"Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicentre retrospective analysis in 225 patients","volume":"30","author":"Brunaud","year":"2016","journal-title":"Surg Endosc"}],"container-title":["Endocrine Connections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ec.bioscientifica.com\/view\/journals\/ec\/15\/4\/EC-25-0921.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ec.bioscientifica.com\/downloadpdf\/journals\/ec\/15\/4\/EC-25-0921.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/ec\/article-pdf\/doi\/10.1530\/EC-25-0921\/504343\/ec-25-0921.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/ec\/article-pdf\/doi\/10.1530\/EC-25-0921\/504343\/ec-25-0921.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:06:04Z","timestamp":1783447564000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/ec\/article\/15\/4\/e250921\/75814\/Preoperative-first-line-amlodipine-in"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1530\/ec-25-0921","relation":{},"ISSN":["2049-3614"],"issn-type":[{"value":"2049-3614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]},"article-number":"e250921"}}