{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:49:56Z","timestamp":1787237396262,"version":"build-2736575974"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Hypertensive crisis represents a significant intraoperative challenge in pheochromocytoma surgery, often necessitating immediate pharmacologic intervention. To reduce this risk, preoperative \u03b1-adrenergic blockade is routinely implemented. Although prior studies have addressed the choice of \u03b1-blockade, the impact of its type, treatment duration, and final titrated dose on hypertensive crisis has not yet been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 110 patients undergoing laparoscopic adrenalectomy for pheochromocytoma. The type of alpha-blocker (doxazosin: DOX vs. phenoxybenzamine: PXB), duration of preoperative preparation, and final titrated dose were evaluated regarding their impact on the risk and duration of intraoperative hypertensive crisis (SBP &amp;gt;200 mmHg).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The duration of hypertensive crisis was significantly longer in the DOX group (median 15.0 (10.0-30.0) vs. 10.0 (5.0-15.0 min, p=0.03). The DOX group demonstrated higher intraoperative vasopressor use (39.6% vs. 10.9%, p&amp;lt;0.001), and a longer perioperative hospitalization compared to the PXB group (median 3.0 (2.2-4.0) vs 2.0 (2.0-3.0), p&amp;lt;0.001). Diabetes, urinary metanephrines &amp;gt;10\u00d7 ULN, and preoperative \u03b1-blockade &amp;gt;30 days were independent risk factors for hypertensive crisis. Prolonged blockade was linked to longer crisis duration and increased vasopressor use, particularly with DOX. The final \u03b1-blocker dose did not influence hypertensive outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Selective \u03b1-blockade with doxazosin resulted in longer hypertensive crises, increased intraoperative vasopressor requirements, and prolonged hospitalization. Prolonged \u03b1-blockade (&amp;gt;30 days) was associated with more frequent and prolonged hypertensive crises and a higher risk of postoperative vasopressor use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1682912","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T05:14:56Z","timestamp":1767762896000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prolonged alpha-blockade and doxazosin are associated with hypertensive crisis in pheochromocytoma surgery"],"prefix":"10.3389","volume":"16","author":[{"given":"Karolina","family":"Zawadzka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Pisarska-Adamczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"Hubalewska-Dydejczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"P\u0119dziwiatr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9185.161665","article-title":"Pheochromocytoma resection: Current concepts in anesthetic management","volume":"31","author":"Ramakrishna","year":"2015","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"B2","doi-asserted-by":"publisher","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":"B3","doi-asserted-by":"publisher","first-page":"e0263737","DOI":"10.1371\/JOURNAL.PONE.0263737","article-title":"The burden of perioperative hypertension\/hypotension: A systematic review","volume":"17","author":"Lizano-D\u00edez","year":"2022","journal-title":"PloS One"},{"key":"B4","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1213\/01.ANE.0000147519.82841.5E","article-title":"Anesthetic management and one-year mortality after noncardiac surgery","volume":"100","author":"Monk","year":"2005","journal-title":"Anesth Analg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1007\/S12350-014-0025-Z","article-title":"2014 ACC\/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on practice guidelines. 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