Preoperative first-line amlodipine in phaeochromocytoma/paraganglioma: perioperative haemodynamic instability and its predictors
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objectives: Preoperative alpha blockade is recommended for phaeochromocytomas and paragangliomas (PPGLs), whereas evidence for calcium channel blockers remains limited. This study evaluated perioperative haemodynamic outcomes with first-line amlodipine for preoperative blockade and identified predictors of intraoperative haemodynamic instability (iHDI). Methods/design: In this monocentric retrospective study, 35 operated PPGL patients who received preoperative first-line amlodipine (July 2021-March 2024) were analysed. Continuous intraoperative arterial pressure recordings were analysed for episodes and duration of hypertension, hypotension, and iHDI. Biochemical phenotype and tumour characteristics were assessed as predictors. Results: The cohort (median age: 32 years; 60% female) included 32 phaeochromocytomas and 3 sympathetic paragangliomas. Germline variants were detected in 20/34 tested patients (cluster 1: 11; cluster 2: 9). Amlodipine up to 20 mg was tolerated in all except two, with a median of 7 days to reach BP targets. Median iHDI duration was 6.67% (0-16.4). On linear regression, log-transformed plasma free metanephrine (PFMN) independently predicted iHDI duration (β = 2.26, P = 0.027). Patients with adrenergic phenotype (n = 13) exhibited a longer duration of SBP ≥ 160 mmHg (14 vs 1 min), a higher peak SBP (201 vs 160 mmHg), and a higher nitroglycerine dose (659 vs 59.6 μg) than those with noradrenergic phenotype. Postoperative hypotension (37.1%) was associated with a higher plasma free normetanephrine level (3,440 vs 1,242.9 ng/L) and a larger tumour size (5.1 vs 4.2 cm). No perioperative mortality occurred. Conclusion: First-line amlodipine blockade was effective in preventing iHDI in PPGLs. Plasma free metanephrine and normetanephrine correlated with intraoperative hypertension and postoperative hypotension, respectively.
Source: Endocrine Connections
DOI: 10.1530/ec-25-0921
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,146
OpenAlex ID: W7140076127
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