Use of doxazosin and phenoxybenzamine in two children with pheochromocytoma

Abstract

Phenoxybenzamine has traditionally been used to control the hypertension associated with pheochromocytoma
in children. However, doxazosin has been proposed as the alternative agent of choice, based upon the claimed
ability to effectively control perioperative hypertension with a single daily dose without the occurrence of
problematic side effects sometimes associated with the use of phenoxybenzamine, e.g. the need for additional
β blockers to control secondary tachycardia or vasopressors to correct resistant hypotension following tumor
removal.
The perioperative course of two siblings, undergoing anesthesia for removal of extra-adrenal pheochromocytomas
(paragangliomas) are compared. Doxazosin and phenoxybenzamine were used in their respective management
for preoperative control of hypertension. The proposed benefits of doxazosin over phenoxybenzamine were
not observed and the intraoperative control of hemodynamics was significantly poorer with doxazosin. The
perioperative course of each sibling is compared and the published evidence supporting the use of doxazosin in
children with pheochromocytoma is critically reviewed.