ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Adrenal Endocrinology
Prolonged Alpha-Blockade and Doxazosin Are Associated With Hypertensive Crisis in Pheochromocytoma Surgery
Provisionally accepted
- 1Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- 22nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- 3Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
- 4Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
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Objective: Hypertensive crisis represents a significant intraoperative challenge in pheochromocytoma surgery, often necessitating immediate pharmacologic intervention. To reduce this risk, preoperative α-adrenergic blockade is routinely implemented. Although prior studies have addressed the choice of α-blockade, the impact of its type, treatment duration, and final titrated dose on hypertensive crisis has not yet been established. Methods: 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 >200 mmHg). Results: 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<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<0.001). Diabetes, urinary metanephrines >10× ULN, and preoperative α-blockade >30 days were independent risk factors for hypertensive crisis. Prolonged blockade was linked to longer crisis duration and increased vasopressor use, particularly with DOX. Final α-blocker dose did not influence hypertensive outcomes. Conclusion: Selective α-blockade with doxazosin resulted in longer hypertensive crises, increased intraoperative vasopressor requirements, and prolonged hospitalization. Prolonged α-blockade (>30 days) was associated with more frequent and prolonged hypertensive crises and a higher risk of postoperative vasopressor use.
Keywords: Pheochromocytoma, Hypertensive crisis, pretreatment, Alpha-blockade, Selective, non-selective
Received: 09 Aug 2025; Accepted: 04 Dec 2025.
Copyright: © 2025 Zawadzka, Pisarska-Adamczyk, Hubalewska-Dydejczyk and Pedziwiatr. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Michal Pedziwiatr
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