[Pheochromocytoma as a challenge for the anesthesiologist]

Pheochromocytoma is a tumour of adrenal chromaffin tissue which produces extreme amounts of catecholamines, and leads to significant haemodynamic disturbances. The anaesthesiologist has an important role in diagnostic procedures of pheochromocytoma (physical examination, biochemical analyses, pharmacological tests, tomographic, scintigraphic, and genetic examinations), and is included in the preparation of the patient for surgery, maintenance of anaesthesia during operation, and postoperative intensive care.

We reviewed 268 patients with adrenal tumours, who were operated on in the Military Medicaf Academy in Belgrade over the period 1974-2002. In 93 (34.7%) patients pheocromocytoma was confirmed. Unilateral localization of tumours was noted in 75 patients (80.6%)), bilateral in 3 patients (3.2%), ectopic in 7 patients (7.5%), and multiple in 3 patients (3.2%). Malignancy was observed in 3 cases (3.2%), and recidivation in 2 cases (2.2%). The most frequent surgical approach was intercostal--by Turner Warvick (72.4%). During a retrospective analysis of complications in perioperative period, we found 3 cases (1.1%) of cardiac arrest, with lethal outcome in one patient (0.4%). In two patients (0.8%) we noted significant intraoperative bleeding (lesion of v.cavae and aortae). In five cases (2.0%) we recorded accidental pleural unilateral lesion, splenectomy in one patient (0.4%), and wound infection in 3 cases (1.1%).

Pheochromocytoma is a rare disease but it is followed by numerous, significant, and very dangerous haemodynamic disturbances. This is the reason for necessity of a multidisciplinary approach in diagnostic procedures and treatment of the disease. Endocrinologists, anaesthesiologists, and surgeons must cooperate at the same time, and only then we can achieve a timely diagnostic, adequate preoperative preparation of the patient, surgical extirpation of tumours, and intensive postoperative care. Our retrospective study shows successful treatment of 268 patients with adrenal tumours and 93 patients with pheochromocytomas.

Pheochromocytoma is a disease with high mortality rate. Surgical extirpation of tumour is the only way for a successful treatment. This tumour is a great challenge for anaesthesiologists, because of numerous disturbances of vital parameters in perioperative period. Low mortality rate in our study (0.4% in all patients, and 1.07% in patients with pheochromocytoma) is the result of an adequate perioperative treatment of our patients. Treatment of this tumour needs hospitalisation in greater clinical centres with adequate personnel and equipment.