Perioperative care of catecholamine-producing tumors

The treatment of catecholamine-producing tumors (pheochromocytoma, paraganglioma [PPGL]) is a challenging task for all disciplines involved in perioperative care (specialists in endocrinology anesthesia and surgery). Hemodynamic and metabolic extreme events are common and may lead to cardiac or cerebrovascular complications. However, both morbidity and mortality are low nowadays due to modern treatment concepts. An alpha-adrenoreceptor blockade, which to date has often been performed dogmatically, cannot prevent intraoperative hemodynamic complications but leads to unpleasant side effects for patients and is therefore criticized. Besides, beta-blockage should only be established in certain situations. Disturbances in glucose and lactate metabolism are common in patients suffering from PPGL, but usually normalize postoperatively. Perioperative care for patients with PPGL should be individualized on the basis of preoperative factors and should be reserved for specialized centers with extensive experience.