{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:51:19Z","timestamp":1792547479448,"version":"4.5.0"},"reference-count":49,"publisher":"Bioscientifica","issue":"6","content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p\/>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Pheochromocytomas and paragangliomas, collectively known as paragangliomas (PGLs), are rare neuroendocrine tumors originating from chromaffin cells. Surgical resection is the treatment of choice, with preoperative \u03b1-adrenoceptor blockade being consistently used prior to any surgical intervention; however, this approach has recently been challenged. This comprehensive systematic review of the literature was conducted across PubMed, Embase, and the Cochrane Library up to December 2025 to address the necessity and potential indications of \u03b1-adrenoceptor blockade in the pre-, peri-, and postoperative phase of PGL management. Papers were categorized into guidelines\/consensus, meta-analyses, and clinical studies. All international guidelines uniformly recommend preoperative \u03b1-adrenoceptor blockade for functional PGLs, albeit there is no substantial evidence to support abandoning this long-standing practice. Therefore, both for medicolegal considerations and for alignment with current clinical practice, the recommendation for preoperative \u03b1-adrenoceptor blockade is still widely utilized. However, recent meta-analyses and patient cohort studies indicate no significant benefits in terms of mortality, intraoperative, or postoperative outcomes using such agents in selective patient populations. The paucity of randomized controlled trials and the recent progress in clinical practice and surgical\/anesthetic techniques underscore the need for a reevaluation of the routine use of \u03b1-adrenoceptor blockade during PGL surgical resections to resolve this issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/erc-26-0007","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:18:48Z","timestamp":1779452328000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-8","source":"Crossref","is-referenced-by-count":2,"title":["Is preoperative adrenoceptor blockade necessary in patients with paraganglioma?"],"prefix":"10.1530","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0906-3617","authenticated-orcid":true,"given":"Anna","family":"Angelousi","sequence":"first","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Memi","sequence":"additional","affiliation":[{"name":"1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George N","family":"Zografos","sequence":"additional","affiliation":[{"name":"2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Chatzellis","sequence":"additional","affiliation":[{"name":"3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Kassi","sequence":"additional","affiliation":[{"name":"4"},{"name":"5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Kaltsas","sequence":"additional","affiliation":[{"name":"5"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"2026070909474186200_bib1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1530\/EJE-21-0692","article-title":"Controversies about the systematic pre-operative pharmacological treatment before pheochromocytoma or paraganglioma surgery","volume":"186","author":"Castinetti","year":"2022","journal-title":"Eur J Endocrinol"},{"key":"2026070909474186200_bib2","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1530\/EJE-20-1301","article-title":"Selective vs non-selective alpha-blockade prior to adrenalectomy for pheochromocytoma: systematic review and meta-analysis","volume":"184","author":"Zawadzka","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"2026070909474186200_bib3","doi-asserted-by":"crossref","first-page":"170","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"},{"key":"2026070909474186200_bib4","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/bmj.1.5534.191","article-title":"Pre-operative and operative management of patients with phaeochromocytoma","volume":"1","author":"Ross","year":"1967","journal-title":"Br Med J"},{"key":"2026070909474186200_bib5","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1038\/s41574-023-00926-0","article-title":"Management of phaeochromocytoma and paraganglioma in patients with germline SDHB pathogenic variants: an international expert consensus statement","volume":"20","author":"Ta\u00efeb","year":"2024","journal-title":"Nat Rev Endocrinol"},{"key":"2026070909474186200_bib6","doi-asserted-by":"crossref","first-page":"200","DOI":"10.4158\/1934-2403-25.2.200","article-title":"A necessity, not a second thought: pre-operative alpha-adrenoceptor blockade in pheochromocytoma patients","volume":"25","author":"Santos","year":"2019","journal-title":"Endocr Pract"},{"key":"2026070909474186200_bib7","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4158\/EP-2018-0455","article-title":"Why take the risk? We only live once: the dangers associated with neglecting a pre-operative alpha adrenoceptor blockade in pheochromocytoma patients","volume":"25","author":"Wolf","year":"2019","journal-title":"Endocr Pract"},{"key":"2026070909474186200_bib8","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026070909474186200_bib9","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S2213-8587(23)00038-4","article-title":"Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline SDHD pathogenic variants","volume":"11","author":"Ta\u00efeb","year":"2023","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026070909474186200_bib10","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1097\/HJH.0000000000002438","article-title":"Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the working group on Endocrine Hypertension of the European Society of Hypertension","volume":"38","author":"Lenders","year":"2020","journal-title":"J Hypertens"},{"key":"2026070909474186200_bib11","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.annonc.2020.08.2099","article-title":"Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Fassnacht","year":"2020","journal-title":"Ann Oncol"},{"key":"2026070909474186200_bib12","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/MPA.0000000000001792","article-title":"The north American Neuroendocrine Tumours Society Consensus Guidelines for surveillance and management of metastatic and\/or unresectable pheochromocytoma and paraganglioma","volume":"50","author":"Fishbein","year":"2021","journal-title":"Pancreas"},{"key":"2026070909474186200_bib13","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1001\/jamasurg.2022.3544","article-title":"American Association of Endocrine Surgeons Guidelines for adrenalectomy: executive summary","volume":"157","author":"Yip","year":"2022","journal-title":"JAMA Surg"},{"key":"2026070909474186200_bib14","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1038\/s41574-024-01034-3","article-title":"Author correction: international consensus statement on the diagnosis and management of phaeochromocytoma and paraganglioma in children and adolescents","volume":"20","author":"Casey","year":"2024","journal-title":"Nat Rev Endocrinol"},{"key":"2026070909474186200_bib15","doi-asserted-by":"crossref","first-page":"024","DOI":"10.1210\/jendso\/bvaf024","article-title":"Pre-operative management of catecholamine-producing pheochromocytomas and paragangliomas-results from a DELPHI process","volume":"9","author":"Bechmann","year":"2025","journal-title":"J Endocr Soc"},{"key":"2026070909474186200_bib16","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1210\/jc.2014-1498","article-title":"Phaeochromocytoma and paraganglioma: an endocrine society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2026070909474186200_bib17","doi-asserted-by":"crossref","first-page":"102","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":"Br J Surg"},{"key":"2026070909474186200_bib18","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1097\/JS9.0000000000000390","article-title":"Pre-operative \u03b1-blockade versus no blockade for pheochromocytoma-paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis","volume":"109","author":"Wang","year":"2023","journal-title":"Int J Surg"},{"key":"2026070909474186200_bib19","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1097\/HJH.0000000000004026","article-title":"Cardiovascular events and biochemically negative paragangliomas: a systematic review","volume":"43","author":"Tsorbatzoglou","year":"2025","journal-title":"J Hypertens"},{"key":"2026070909474186200_bib20","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1007\/s00268-018-4488-y","article-title":"Minimally invasive surgery in children and adolescents with pheochromocytomas and retroperitoneal paragangliomas: experiences in 42 patients","volume":"42","author":"Walz","year":"2018","journal-title":"World J Surg"},{"key":"2026070909474186200_bib21","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1093\/bjs\/znab199","article-title":"Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine\u00ae database","volume":"108","author":"Hallin Thompson","year":"2021","journal-title":"Br J Surg"},{"key":"2026070909474186200_bib22","doi-asserted-by":"crossref","DOI":"10.1093\/bjs\/znad178.011","article-title":"Change in perioperative management of 14 consecutive patients with pheochromocytoma \u2013 is alpha blockade still necessary?","volume":"110","author":"Goldmann","year":"2023","journal-title":"BJS"},{"key":"2026070909474186200_bib23","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00268-022-06731-6","article-title":"Cardiac changes and their reversal following curative surgery in pheochromocytoma: pheocard prospective cohort study","volume":"47","author":"Vishvak Chanthar","year":"2023","journal-title":"World J Surg"},{"key":"2026070909474186200_bib24","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":"2026070909474186200_bib25","doi-asserted-by":"crossref","first-page":"508.e6\u201311","DOI":"10.1016\/j.urology.2010.03.032","article-title":"Comparison of two preoperative medical management strategies for laparoscopic resection of pheochromocytoma","volume":"76","author":"Weingarten","year":"2010","journal-title":"Urology"},{"key":"2026070909474186200_bib26","first-page":"223","article-title":"Perioperative risk factors, morbidity, and outcome of 145 patients during phaeochromocytoma resection","volume":"111","author":"Kazic","year":"2011","journal-title":"Acta Chir Belg"},{"key":"2026070909474186200_bib27","doi-asserted-by":"crossref","first-page":"4175","DOI":"10.1245\/s10434-015-4519-y","article-title":"Hemodynamic stability during pheochromocytoma resection: lessons learned over the last two decades","volume":"22","author":"Livingstone","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"2026070909474186200_bib28","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/EJA.0000000000000941","article-title":"The hemodynamic instability score: development and internal validation of a new rating method of intraoperative hemodynamic instability","volume":"36","author":"Buitenwerf","year":"2019","journal-title":"Eur J Anaesthesiol"},{"key":"2026070909474186200_bib29","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1308\/rcsann.2021.0133","article-title":"To block, or not to block \u2026 is it still the question? Effectiveness of alpha- and beta-blockade in phaeochromocytoma surgery: an institutional analysis","volume":"104","author":"Van Den Heede","year":"2022","journal-title":"Ann R Coll Surg Engl"},{"key":"2026070909474186200_bib30","doi-asserted-by":"crossref","first-page":"2907","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":"2026070909474186200_bib31","doi-asserted-by":"crossref","first-page":"7471","DOI":"10.3390\/jcm11247471","article-title":"Hemodynamic instability during surgery for pheochromocytoma: a retrospective cohort analysis","volume":"11","author":"Senne","year":"2022","journal-title":"J Clin Med"},{"key":"2026070909474186200_bib32","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.2147\/DDDT.S378796","article-title":"Non-selective alpha-blockers provide more stable intraoperative hemodynamic control compared with selective alpha1-blockers in patients with pheochromocytoma and paraganglioma: a single-center retrospective cohort study with a propensity score-matched analysis from China","volume":"16","author":"Yang","year":"2022","journal-title":"Drug Des Devel Ther"},{"key":"2026070909474186200_bib33","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2023.1174836","article-title":"Risk factors for postoperative complications after pheochromocytoma and\/or paraganglioma: a single-center retrospective study","volume":"13","author":"Ma","year":"2023","journal-title":"Front Oncol"},{"key":"2026070909474186200_bib34","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.ejso.2022.10.006","article-title":"Risk factors for postoperative hypotension after adrenalectomy for phaeochromocytoma: derivation of the PACS risk score","volume":"49","author":"Parente","year":"2023","journal-title":"Eur J Surg Oncol"},{"key":"2026070909474186200_bib35","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/HJH.0000000000003596","article-title":"Risk factors for intraoperative hypertensive crisis in patients with pheochromocytomas and sympathetic paragangliomas","volume":"42","author":"Araujo-Castro","year":"2024","journal-title":"J Hypertens"},{"key":"2026070909474186200_bib36","article-title":"Exploration of factors affecting hemodynamic stability following pheochromocytoma resection \u2013 cohort study","volume":"15","author":"Liu","year":"2024","journal-title":"Front Endocrinol"},{"key":"2026070909474186200_bib37","doi-asserted-by":"crossref","first-page":"7054","DOI":"10.3390\/jcm13237054","article-title":"Hypotension with and without hypertensive episodes during endoscopic adrenalectomy for pheochromocytoma or paraganglioma-should perioperative treatment be individualized?","volume":"13","author":"Tiboldi","year":"2024","journal-title":"J Clin Med"},{"key":"2026070909474186200_bib38","article-title":"Perioperative hemodynamic instability in pheochromocytoma and sympathetic paraganglioma patients","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"2026070909474186200_bib39","doi-asserted-by":"crossref","first-page":"729","DOI":"10.21037\/gs.2019.11.22","article-title":"Incidence, risk factors and clinical significance of postoperative hemodynamic instability after adrenalectomy for phaeochromocytoma","volume":"8","author":"Thompson","year":"2019","journal-title":"Gland Surg"},{"key":"2026070909474186200_bib40","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"},{"key":"2026070909474186200_bib41","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"2026070909474186200_bib42","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":"2026070909474186200_bib43","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/bja\/aew392","article-title":"Perioperative \u03b1-adrenergic receptor blockade in phaeochromocytoma surgery: an observational case series","volume":"118","author":"Groeben","year":"2017","journal-title":"Br J Anaesth"},{"key":"2026070909474186200_bib44","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":"2026070909474186200_bib45","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/ncpendmet0396","article-title":"International symposium on pheochromocytoma. Pheochromocytoma: recommendations for clinical practice from the First International Symposium","volume":"3","author":"Pacak","year":"2007","journal-title":"Nat Clin Pract Endocrinol Metab"},{"key":"2026070909474186200_bib46","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2024-262827","article-title":"Pheochromocytoma-induced cardiogenic shock requiring ECMO: cardiovascular recovery prior to surgical resection","volume":"17","author":"Redler","year":"2024","journal-title":"BMJ Case Rep"},{"key":"2026070909474186200_bib47","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1186\/s12871-024-02850-w","article-title":"Unexpected pheochromocytoma leading to cardiac arrest during the perioperative period: a case report and literature review","volume":"24","author":"Guo","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"2026070909474186200_bib48","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1161\/01.RES.61.1.86","article-title":"Desensitization of postjunctional alpha 1- and alpha 2-adrenergic receptor-mediated vasopressor responses in rat harboring pheochromocytoma","volume":"61","author":"Tsujimoto","year":"1987","journal-title":"Circ Res"},{"key":"2026070909474186200_bib49","article-title":"Recent advances in algorithms predicting hemodynamic instability undergoing surgery for phaeochromocytoma and paraganglioma","volume":"238","author":"Guan","year":"2024","journal-title":"Best Pract Res Clin Endocrinol Metab"}],"container-title":["Endocrine-Related Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/erc.bioscientifica.com\/view\/journals\/erc\/33\/6\/ERC-26-0007.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/erc.bioscientifica.com\/downloadpdf\/journals\/erc\/33\/6\/ERC-26-0007.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/erc\/article-pdf\/doi\/10.1530\/ERC-26-0007\/519971\/erc-26-0007.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/erc\/article-pdf\/doi\/10.1530\/ERC-26-0007\/519971\/erc-26-0007.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:47:56Z","timestamp":1783604876000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/erc\/article\/33\/6\/e260007\/77582\/Is-preoperative-adrenoceptor-blockade-necessary-in"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":49,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1530\/erc-26-0007","relation":{},"ISSN":["1479-6821","1351-0088"],"issn-type":[{"value":"1479-6821","type":"electronic"},{"value":"1351-0088","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"article-number":"e260007"}}