Diagnosis

• It is recommended that all hypertensive patients be screened for pheochromocytoma because of the potentially fatal consequence of undiagnosed disease
• Five percent of all cases will have normal catecholamines
• Radiologic Diagnosis
  • The MRI is the imaging study of choice to localize pheochromocytoma
    • The site of the lesion is localized.
    • Multiple lesions can be localized
    • The T2-weighted image of the characteristic bright "light bulb" appearance
    • Adjacent structures and venous drainage can be identified
  • Metaiodobenzylguanidine (MIBG) scanning localizes to catechol-secreting tissue and is especially useful in patients with multiple or recurrent lesions

Treatment

• Preoperative
  • Alpha-adrenergic blockade with phenoxybenzamine to a dose to normalize blood pressure
  • Beta-adrenergic blockade if cardiac arrhythmias persist
  • Alpha-methylparatyrosine-a tyrosine hydroxylase inhibitor (Fig. 24-3) to reduce catecholamine production
• Surgical
  • Laparoscopic removal for tumors less than 5 cm.
  • Open removal for tumors greater than 5 cm
• Postoperative
  • Observe closely for hypotension and arrhythmias

References

• Blumenfeld JD, Schlusse, Sealey JE, et al: Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med, 121:877-885, 1994.
• Blumenfeld JD, Vaughan ED Jr.: The adrenals. In: Campbell's Urology. 7th Ed. Philadelphia, Saunders, 1998, pp. 2915-2971.
• Manger WM, Gifford RW Jr.: Pheochromocytoma. A clinical review. In: Hypertension Pathophysiology, Diagnosis, and Management. Laragh JH, Brenner BM, eds. 1995, pp. 2225-2246.
• Orth DN: Cushing syndrome. N Eng J Med 332:791-795, 1995.
• Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC: Successful outcomes in pheochromocytoma surgery in the modern era. J Urol 161:764-767, 1999. Vaughan ED Jr.: Adrenal surgery. F. F. Marshall, Ed. In: Textbook of Operative Surgery. Philadelphia, Saunders, 1996, p 220-230.
• Vaughan ED Jr., (ed): Diagnosis and treatments of adrenal disorders. World J Urol 17:1064, 1999.

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