What is the treatment of choice for pheochromocytomas?

Updated: Aug 10, 2018
  • Author: Michael A Blake, MBBCh, MRCPI, FRCR; Chief Editor: George T Griffing, MD  more...
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Answer

Surgical resection of the tumor is the treatment of choice for pheochromocytoma and usually results in cure of the hypertension. Careful preoperative management is required to control blood pressure, correct fluid volume, and prevent intraoperative hypertensive crises. [55]  A study by Kwon et al indicated that independent risk factors for a hypertensive attack during adrenalectomy for pheochromocytoma include a large tumor size and preoperative elevation of the urinary epinephrine level. [56]

A retrospective study by Butz et al found that among patients with pheochromocytoma/paraganglioma associated with neurofibromatosis type 1 (NF1), multiple endocrine neoplasia type 2A (MEN 2A), or von Hippel-Lindau (VHL) disease, the most volatile intraoperative course hemodynamically, as well as more severe postoperative complications, occurred in patients with NF1. The investigators attributed this to the presence of large tumors secreting great amounts of catecholamine in these patients, along with the high proportion of the NF1 patients who were treated with open resection. Postoperative outcomes between the three groups did not differ significantly for patients who were treated laparoscopically. [57]


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