Management of Pheochromocytoma

Abstract

Pheochromocytomas are catecholamine-secreting tumors located in the adrenal gland. Patients may present with incidentally found adrenal nodules but commonly have symptoms related to catecholamine excess including paroxysmal hypertension, tremors, palpitations, and diaphoresis. Biochemical evaluation should include serum metanephrines with confirmatory testing with urinary catecholamines, including dopamine and creatinine for adequacy of sample. Cross-sectional imaging should be performed with and without intravenous (IV) contrast for localization. Pheochromocytomas typically show marked enhancement and are greater than 3 cm. Biopsy of the adrenal gland should never be performed. Surgical management with laparoscopic adrenalectomy unless the tumor is greater than 6 cm or has concerning imaging features suggestive of malignancy. Preoperative alpha blockade should be performed until the patient develops orthostatic hypotension, at which point beta blockade should be added to counteract rebound tachycardia.