Management of pheochromocytoma

In caring for these patients and reviewing their clinical records a number of points evolved which are not emphasized in standard sources: With a suspected pheochromocytoma, arteriography, if it is to be carried out, should be done only after alpha adrenergic blockade. A physician familiar with the use of blocking agents and norepinephrine should be present with the patient during the procedure. Arteriography can prove helpful but is not essential unless the flank approach is to be used to remove the lesion. Inability to visualize a tumor in one site does not relieve the surgeon of the obligation to search all other areas containing chromaffin tissue. Wide fluctuations in blood pressure and need for large volumes of transfused blood are minimized by adequate preoperative preparation with Phenoxybenzamine. The correct dose of Phenoxybenzamine is the amount required to correct hypertension. In practice, this is frequently as much as 200 mgm per 24 hr. The operative approach may be either transabdominal transperitoneal or flank retroperitoneal, depending upon the probability of multiple lesions, the certainty of arteriographic localization, the size of the identified lesion, the cardiopulmonary status of the patient and his habitus. Palpation alone, without opening the retroperitoneal space, is inadequate to rule out an adrenal pheochromocytoma. Multiple lesions may occur within one gland.