The evaluation and management of pheochromocytomas

Despite the relative infrequency of pheochromocytomas, they remain a potentially curable yet lethal etiology of hypertension. Appropriate utilization of a modern clinical chemistry laboratory and sophisticated radiologic techniques should allow a suspecting physician to establish the presence or absence of such a catecholamine-secreting tumor. The treatment of pheochromocytoma remains surgical; however, strict attention to preoperative details is crucial if mortality is to be minimized. Judicious use of adrenergic blocking agents and measures to ensure a normal circulating blood volume are of utmost importance during the preoperative period. Surgery remains the ultimate diagnostic and therapeutic maneuver. A thorough and meticulous exploration of the entire abdominal cavity and both adrenal beds is essential in all patients with pheochromocytoma. Monitoring of electrocardiographic and hemodynamic parameters is critical during surgery and postoperatively, since changes in cardiovascular stability can be dramatic and rapid. Appropriate measures must be taken to reverse such changes but must be made based on a thorough understanding of the effects of catecholamines, the drugs available to alter these effects, and the potential problems that patients with pheochromocytomas are likely to experience.