Pheochromocytoma Treatment

Treatment

Pharmacotherapy

Alpha-Adrenergic Blockade

First-line therapy used to minimize complications prior to surgery

Phenoxybenzamine

Action: Powerful irreversible alpha-adrenergic blocker of the alpha receptors in the smooth muscles
Effects: Oral administration results in an onset of action w/in a few hr & persists for up to 3-4 days
- Used to control the hypertension caused by excessive catecholamine release by pheochromocytoma

Selective Alpha₁-Antagonists

Eg Doxazosin
Action: Selective blockade of alpha₁-adrenoreceptors
Effects: Limited use in pheochromocytoma, Phenoxybenzamine is more effective
May be used to treat individual paroxysms
May also may be used to treat hypertension while pheochromocytoma workup is ongoing
- Better tolerated than Phenoxybenzamine
- Prevent serious pressor crisis if pheochromocytoma is present

Beta-Blockers

Eg Propranolol, Atenolol
Administer only after alpha blockade has been induced
- W/o alpha blockade paradox increase in BP may occur

Action: Competitive antagonists of catecholamines at beta-adrenergic receptors
Effects: Used to treat tachycardia that may develop w/ alpha blockade
- Assist in preventing catecholamine-induced arrhythmias

Low doses are usually sufficient

Calcium Channel Blockers

Eg Nifedipine, Amlodipine
Used as add-on treatment to alpha-adrenergic receptor blockers to further improve cardiovascular function peri-operatively
Action: Blocks slow calcium channels to prevent calcium ion flow into the cell
Effects: Vasodilatation, reduced afterload, peripheral resistance & blood pressure

Metirosine (Metyrosine)

Action: Inhibits tyrosine hydroxylase which inhibits synthesis of catecholamines by the tumor
Effects: Simplifies chronic management
Should be used if other agents are ineffective or when tumor destruction will be marked

HK in CKD: Do diet, HD frequency matter?

Elvira Manzano, 28 Jun 2020

Hyperkalaemia (HK) occurrence and recurrence are frequent in advanced CKD*, creating a perfect storm for cardiovascular events and death, says Professor Juan-Jesus Carrero from the Karolinska Institute, Solna, Sweden, at ERA-EDTA 2020. Given these risks, acutely elevated potassium (K+) should merit clinical attention.

Continuous glucose monitoring versus self-monitoring of blood glucose: A healthcare professional’s perspective

26 Aug 2021

Technological advancements have improved glucose monitoring and diabetes care, as well as empowered patients in self-care. The introduction of continuous glucose monitoring systems (CGM), such as the Abbott FreeStyle Libre^TM, offers patients an alternative and additional advantages to self-monitoring of blood glucose (SMBG).

Empagliflozin’s clinical endorsement: Revolutionising guidelines across specialties

08 Jun 2020

In this third issue we take a look at how empagliflozin made a bold impact on clinical guidelines across multiple specialties. We will explore how existing treatment recommendations were altered, and summarise the current guidelines and future perspectives of empagliflozin’s use.