{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:08:19Z","timestamp":1790845699782,"version":"4.1.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:p>The question of systematic use of a pharmacological treatment before surgery in patients diagnosed with pheochromocytoma and paraganglioma (PPGL) remains highly controversial. While recent guidelines suggest that this should be used in all patients, some experienced teams consider it unnecessary in some cases, provided the surgery is performed in a dedicated center that has expert endocrinologists, cardiologists, surgeons, and anesthetists. This controversy is aimed at shedding light on the potential benefits and risks of such a treatment, focusing specifically on alpha blockers which are considered as the first-line medical treatments in patients with PPGL. After discussing the rationale for alpha blockers, hemodynamic instability, tolerance, and acute cardiac complications will then be discussed in the first part of the manuscript, defending a systematic use. The second section will focus on blood pressure control, tolerance of alpha blockers, and also the management of normotensive PPGL, examining the daily risks of PPGL and arguing against the systematic use of a preoperative pharmacological treatment before surgery. Finally, we will discuss the concept of expert centers and define the patients in whom the risk\/benefit profile would favor the use of this preoperative treatment.<\/jats:p>","DOI":"10.1530\/eje-21-0692","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T16:43:14Z","timestamp":1646152994000},"page":"D17-D24","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":26,"title":["Controversies about the systematic preoperative pharmacological treatment before pheochromocytoma or paraganglioma surgery"],"prefix":"10.1093","volume":"186","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1808-8800","authenticated-orcid":true,"given":"Frederic","family":"Castinetti","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Aix Marseille Universit\u00e9, APHM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Baptiste","family":"De Freminville","sequence":"additional","affiliation":[{"name":"AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou, Hypertension Unit, Paris, France"},{"name":"Universit\u00e9 de Paris, Paris, France"},{"name":"PARCC, INSERM UMR970 and Reference Centre for Rare Adrenal Diseases, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Guerin","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, APHM, La Conception Hospital, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Cornu","sequence":"additional","affiliation":[{"name":"AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou, Hypertension Unit, Paris, France"},{"name":"Universit\u00e9 de Paris, Paris, France"},{"name":"PARCC, INSERM UMR970 and Reference Centre for Rare Adrenal Diseases, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Sarlon","sequence":"additional","affiliation":[{"name":"Cardiology Department, APHM, HTA and Vascular Medicine University Hospital Timone, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Amar","sequence":"additional","affiliation":[{"name":"AP-HP, H\u00f4pital Europ\u00e9en Georges Pompidou, Hypertension Unit, Paris, France"},{"name":"Universit\u00e9 de Paris, Paris, France"},{"name":"PARCC, INSERM UMR970 and Reference Centre for Rare Adrenal Diseases, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"bib1","series-title":"Journal of Clinical Endocrinology and Metabolism","doi-asserted-by":"publisher","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","unstructured":"Lenders JWDuh QYEisenhofer GGimenez-Roqueplo APGrebe SKMurad MHNaruse MPacak KYoung Jr WF & Endocrine Society. 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Metastatic pheochromocytoma and paraganglioma: management of endocrine manifestations, surgery and ablative procedures, and systemic therapies. Best Practice and Research: Clinical Endocrinology and Metabolism202034101354. (https:\/\/doi.org\/10.1016\/j.beem.2019.101354)10.1016\/j.beem.2019.101354"},{"key":"bib22","series-title":"Cancers","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.3390\/cancers11101505","article-title":"Current management of pheochromocytoma\/paraganglioma: a guide for the practicing clinician in the era of precision medicine","volume":"11","author":"Nolting","year":"2019","unstructured":"Nolting SUllrich MPietzsch JZiegler CGEisenhofer GGrossman APacak K. Current management of pheochromocytoma\/paraganglioma: a guide for the practicing clinician in the era of precision medicine. Cancers2019111505. 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