Pheochromocytoma: clinical diagnosis and management

The incidence of pheochromocytoma among the hypertensive population is less than 1%. One third of the patients have intermittent hypertension, one third have remittent hypertension, and one third have persistent hypertension. The most common symptoms accompanying paroxysms include palpitation, headache, sweating, and pallor. Several familial syndromes have been described and should be searched for in every case of pheochromocytoma. Indications for screening for this tumor include severe and progressive hypertension, labile hypertension, or paroxysmal, symptomatic hypertension. In the majority of cases, diagnosis can be established by urinary assays for vanillylmandelic acid (VMA) and metanephrine. Plasma catecholamine determinations and computerized axial tomography have added other dimensions to the preoperative diagnosis and localization of this tumor. Surgery is obviously the treatment of choice. Preoperative alpha-blockade ameliorates clinical manifestations, allows volume expansion, and allows safe induction of anethesia.