Pheochromocytoma. A persistently problematic and still potentially lethal disease

Fifty patients with pheochromocytomas have had their conditions diagnosed and have been treated by these authors during a 13-year peneod. Three patients died in the postoperative period, for an overall mortality of 6%. Thirty-two patients underwent primary excision without fatality. Eighteen patients had more complicated illnesses associated with recurrences, notable other disease, acute catecholamine crisis, and/or pregnancy. All three postoperative deaths occurred in this group. Diagnosis was made by urinary catecholamine analysis of epinephrine, norepinephrine, metanephrine, and normetanephrine. Localization was done by plain films, ultrasonograms, computerized tomograms, radioactive isotope scans, intravenous pyelograms, caval samples, venograms, and arteriograms. Management of these complicated cases requires prompt and accurate diagnosis, availability of sophisticated methods of tumor localization, and thoughtful awareness of the potential outcome by an experienced team of surgeons and anesthesiologists.