Pheochromocytoma / paraganglioma surgery (adrenalectomy) is planned or imminent WITHOUT d...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-PHEO-INADEQUATE-ALPHA-BLOCKADE`
Type	Red flag
Status	reviewed 2026-07-11 \| pending_clinical_signoff
Diseases	`DIS-PHEOCHROMOCYTOMA`
Sources	`SRC-ENDOCRINE-SOCIETY-PPGL-2014` `SRC-NCCN-NET-2025`

Red Flag Origin

Definition	Pheochromocytoma / paraganglioma surgery (adrenalectomy) is planned or imminent WITHOUT documented adequate preoperative alpha-adrenergic blockade (phenoxybenzamine or doxazosin). Adequate alpha-blockade is mandatory before surgery to prevent an intraoperative hypertensive crisis from catecholamine release during tumor manipulation (Endocrine Society 2014 PPGL guideline). This is a hard sequencing / safety gate, NOT a treatment-selection preference.
Clinical direction	hold
Category	fitness-eligibility
Shifts algorithm	ALGO-PHEO-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "preop_alpha_blockade_adequate",
      "value": false
    },
    {
      "finding": "preop_alpha_blockade_adequate",
      "value": null
    },
    {
      "condition": "Adrenalectomy or paraganglioma resection planned without a documented completed course of preoperative alpha-adrenergic blockade"
    }
  ],
  "type": "clinical_precondition"
}

Notes

Models the narrative's hard requirement that "adequate preoperative alpha-blockade ... is MANDATORY before surgery to prevent intraoperative hypertensive crisis" as an explicit engine-visible safety gate (clinical_direction: hold) rather than free prose. Wired onto IND-PHEO-LOCALIZED-1L-ALPHA-BLOCKADE-ADRENALECTOMY via red_flags_triggering_alternative -- firing this RedFlag means surgery must be HELD, not redirected to a different regimen (the KB schema has no dedicated "required precondition" field on Indication, so red_flags_triggering_alternative is repurposed here for a hold-type gate, consistent with clinical_direction: hold already existing elsewhere in this KB for similar organ-readiness gates, e.g. RF-PDAC-BILIARY-OBSTRUCTION-CHOLANGITIS). No specific numeric duration or target BP/HR threshold is asserted -- "adequate" blockade is intentionally left as a clinical-judgment finding (preop_alpha_blockade_adequate), not an invented number, per CHARTER §8.3. draft:true pending clinical co-lead signoff (CHARTER §6.1, dev-mode-exempted).

Used By

Algorithms

ALGO-PHEO-1L - ALGO-PHEO-1L

Diseases

DIS-PHEOCHROMOCYTOMA - Pheochromocytoma and paraganglioma (PPGL)

Drug

DRUG-DOXAZOSIN - Doxazosin
DRUG-PHENOXYBENZAMINE - Phenoxybenzamine

Indications

IND-PHEO-LOCALIZED-1L-ALPHA-BLOCKADE-ADRENALECTOMY - IND-PHEO-LOCALIZED-1L-ALPHA-BLOCKADE-ADRENALECTOMY

Regimens

REG-ALPHA-BLOCKADE-PREOP-PHEO - Preoperative alpha-adrenergic blockade (phenoxybenzamine, before pheochromocytoma/paragan...