The combination of doxazosin and metyrosine as a preoperative treatment for pheochromocytomas and paragangliomas

期刊论文
发表日期：

2024年1月11日

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Yuka Ohmachi,
Masaaki Yamamoto,
Yuiko Inaba,
Shohei Makino,
Shin Urai,
Risa Matsumoto,
Hironori Bando,
Keitaro Kanie,
Yasutaka Tsujimoto,
Yuma Motomura,
Yuriko Sasaki,
Yuka Oi-Yo,
Naoki Yamamoto,
Masaki Suzuki,
Michiko Takahashi,
Genzo Iguchi,
Maki Kanzawa,
Junya Furukawa,
Katsumi Shigemura,
Satoshi Mizobuchi,
Wataru Ogawa,
Hidenori Fukuoka

摘要

Purpose

Preoperative medical management is critical to prevent intraoperative cardiovascular complications in patients with pheochromocytomas and paragangliomas (PPGLs). Initial treatment involves α-adrenergic receptor blockers. However, while the routine use of metyrosine alongside these blockers is not strongly recommended due to a lack of evidence supporting its efficacy and associated safety concerns, there are previous studies on combination therapy with phenoxybenzamine and metyrosine. There are few reports on combination therapy with the selective α1-adrenergic receptor blocker doxazosin. Therefore, we investigated this combination treatment, which theoretically can affect perioperative outcomes in patients with PPGLs. To our knowledge, this is the first such study.

Methods

This retrospective single-center observational study involved 51 patients who underwent surgical resection of PPGLs at Kobe University Hospital between 2014 and 2022. All patients received doxazosin at maximum doses. Fourteen patients received concomitant metyrosine, while 37 received doxazosin alone. Their perioperative outcomes were compared.

Results

No severe event, such as acute coronary syndrome, was observed in either group. Intraoperatively, the doxazosin + metyrosine group exhibited a lower median minimum systolic blood pressure (56 [54–60] vs. 68 [59–74] mmHg, P = 0.03) and required lower median remifentanil (P = 0.04) and diltiazem (P = 0.02) doses than the doxazosin-alone group.

Conclusion

The combination of metyrosine and doxazosin as a preoperative treatment for PPGLs affects intraoperative circulatory hemodynamics, such as a reduced occurrence of blood pressure elevation during surgery. Further research is necessary to identify patients who will benefit most from this combination treatment.