Surgical management of phaeochromocytoma

Phaeochromocytoma is a rare tumour, which is benign but metabolically functional, with a potential for malignancy. Surgical resection is the primary treatment. The purpose of this study was to identify the presenting features, diagnostic tests and appropriate surgical approaches for phaeochromocytoma.

Retrospective analysis was performed on 26 patients with phaeochromocytoma who were admitted to General Surgery, Department of Postgraduate Institute of Medical Education and Research, Chandigarh, India from 1993 to 1999.

Of the 26 patients, 15 were males and 11 were females. Their ages ranged from 13 to 60 years, with a peak phaeochromocytoma incidence in the second decade of life. Two patients had phaeochromocytoma as a manifestation of multiple endocrine neoplasia type 2 syndrome (MEN-2). Hypertension was present in 92% of patients. Six (23%) patients had extra-adrenal phaeochromocytoma. The incidence of bilateral tumour was 25% of adrenal tumour and 11.5% had malignant phaeochromocytoma. The diagnostic measurements were: 1) plasma catecholamines, 2) 24-hour urinary vanillylmandelic acid and 3) fractionated urinary catecholamines. Computed tomography of the abdomen was extremely accurate in diagnosing phaeochromocytoma (92% accuracy). Magnetic resonance imaging was performed in 2 patients with 100% accuracy. Preoperatively, all the patients were put on alpha adrenergic blocking agents to control blood pressure for varying periods of time. The transabdominal midline approach was used in all cases with excellent results. There was no surgical mortality. All the resected specimens were subjected to histopathological examination and phaeochromocytoma was subsequently confirmed.

If preoperative diagnosis and localization of phaeochromocytoma is accurate, surgical resection can be done with minimal morbidity and mortality.