Pheochromocytoma - review

Clinical features of pheochromocytoma

Epidemiology Adults; both sexes; all ages,
especially 30-50 years.
Biologic behavior 90% benign; 10% malignant.
Secretion High levels of cathecolamines;
produce predominantly
norepinephrine
Clinical presentation Episodic or sustained hypertension,
sweating, palpitations,
hyperglycemia, glycosuria
Macroscopic features Mass, often hemorrhagic; 10%
bilateral; 10% extra-adrenal.
Adrenoceptor-mediated response
on target organs
Most common symptoms, and why

Effector organs Receptor type Responses Revelant clinical manifestation

Heart
SA node β1, β2 Increase in heart rate Palpitations
Arterioles
Skeletal muscle α, β2* Constriction, dilations Hypertension
Skin
Sweat glands α1 Localized secretion Sweating
Pancreas
Islets (β cells) α2 Decreased secretion Hyperglycemia
Skin
Skeletal muscle β2 Increased contractility Hyperglycemia
Glycogenolysis
*PHEOs that produce purely epinephrine which can produce hypertension from alpha stimulation but can also
produce hypotension from predominantly β-stimulated vasodilation.

The mechanism of the headache in patients with pheochromocytoma is not fully

understood. In addition to the arterial hypertension, vasodilator peptides produced
by the tumor may play important roles.

Pacak, K. (2007). Preoperative management of the pheochromocytoma patient. The Journal of Clinical Endocrinology & Metabolism, 92(11).
Watanabe, M. (2011). Headache in Pheochromocytoma. In Pheochromocytoma-A New View of the Old Problem. InTech.
 Management
• Surgical excision is the most effective method
for the treatment of PHEOs.

• The goal of preoperative care is to prevent a

sudden release of catecholamines or attenuate
the response to a release of catecholamines

• PHEO has pathophysiological characteristics

of blood volume and hypertension, therefore,
controlling BP is key.
 Which preoperative drugs
should been used?
• Alpha-adrenoceptor
antagonists.

• Phenoxybenzamine,
most important agent
in the preoperative
management of
pheochromocytomas.

• Most commonly given

1-3 weeks prior to
OR.
 Alpha and beta blockers

B adrenergic antagonist help control tachycardia and tachyarrhythmia.

Which intraoperative drugs
should be used?
 Complications after surgery
• Significant hypotensive episodes also can
occur and are associated with a sudden
decrease in catecholamine levels after removal
of the tumor.
• Hyperglycemia can occur before tumor
removal as a result of catecholamine excess,
and rebound hyperinsulinemia may cause
postoperative hypoglycemia.
Case 2 - Questions
• What drugs would you use to premedicate the
patient?
• Why is adenosine or atropine not indicated?
• What acute abnormalities might be found
following surgery?
• Why is it important to check glucose levels
regularly after surgery?