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47 years of phaeochromocytomas
T O'Halloran1, G McGreal, E McDermott
1Department of Surgery, St. Vincent's Hospital, Dublin.
Irish Medical Journal
|November 6, 2001
Summary
Surgical outcomes for phaeochromocytoma have significantly improved due to advancements in diagnostic techniques and peri-operative care. This study highlights the evolution of managing this rare adrenal tumor, showing a decrease in surgical mortality over nearly five decades.
Area of Science:
- Endocrinology
- Surgical Oncology
- Nephrology
Background:
- Phaeochromocytomas are rare neuroendocrine tumors of the adrenal medulla.
- These tumors can cause significant morbidity and mortality due to catecholamine excess.
- Surgical resection is the primary treatment modality.
Purpose of the Study:
- To review the surgical management of phaeochromocytomas.
- To analyze diagnostic trends and outcomes over a 47-year period.
- To assess peri-operative mortality and long-term survival.
Main Methods:
- Retrospective review of 33 patients undergoing phaeochromocytoma surgery from 1950-1997.
- Analysis of diagnostic methods including phentolamine testing, urinary VMA, catecholamines, IVP, CT, ultrasound, and MIBG scanning.
- Evaluation of peri-operative complications and mortality.
Main Results:
- Hypertension, palpitations, and sweating were cardinal symptoms in most patients.
- Early surgical mortality (pre-1967) was 17.6% (3/17), primarily due to stroke and pulmonary embolism.
- No peri-operative deaths occurred in patients operated on after 1967.
- Malignant phaeochromocytomas occurred in 2 patients, with one death from metastatic disease.
- Four cases involved phaeochromocytomas diagnosed during pregnancy.
Conclusions:
- Surgical management of phaeochromocytoma has evolved significantly, with improved diagnostic accuracy and surgical techniques.
- Advances in peri-operative care have drastically reduced surgical mortality.
- Long-term outcomes depend on tumor characteristics, with malignant cases posing a persistent risk.