Small pheochromocytomas: significance, diagnosis, and outcome

To address the unique challenges in the diagnosis and management of small pheochromocytomas, the authors performed a retrospective study of 24 patients with small pheochromocytomas (≤ 3 cm) treated between 1995 and 2011, using 51 patients with larger pheochromocytomas (> 3 cm) as controls. Patient demographics were similar between the two groups. Small pheochromocytomas presented mainly as adrenal mass and hypertension and their major complication was hypertensive crisis during unrelated procedures in 4 patients (17%). Hypertension was improved in a quarter of the patients after pheochromocytoma resection. The biochemical marker levels in patients with small pheochromocytomas were generally lower than those with larger tumors and half of the patients exhibited modestly elevated or normal levels. The authors conclude that small pheochromocytomas are frequent and may not contribute to baseline hypertension, but can cause hypertensive crisis during unrelated medical procedures. Small pheochromocytomas should be removed to prevent hypertensive crisis and future complications of pheochromocytoma.