Pheochromocytoma - an institutional experience

Abstract

Objective: The present study envisages evaluating the clinical presentation, diagnosis, management, with particular reference to pharmacological and anesthetic considerations, and outcome in patients with pheochromocytoma. Design: A retrospective study. Place and Duration of Study: The study was conducted at the Department of Surgery, Kasturba Medical College Hospital, Manipal, India from January 1, 1996 to December 31, 2003. Patients and Methods: Seventeen patients diagnosed to have pheochromocytoma were included for this study. Our assessment of age at presentation, sex, presenting complaints with details of hypertension (HT), diagnostic tests, surgical procedure and follow-up was based on patient records. Results: Peak incidence was observed in 40-50 years age group, with male preponderance. All the patients had diastolic HT of more than 100 mm of Hg at presentation. Systolic blood pressures (SBP) were between 150 mm Hg to 230 mm Hg, with mean of 170 mm Hg; nine patients presented with persistent HT and seven had paroxysmal HT. One patient infact presented with hypotension due to septic shock and was incidentally detected to have an adrenal tumor. Computed tomography (CT) scan and urinary levels of vanillylmandelic acid (VMA) were mainstay of diagnosis. These patients had adequate preoperative control of HT. All patients underwent exploration of the tumor by an extraperitoneal approach. 70% tumors were on the right and 30% were on the left side. Histopathologically, all the tumors were benign except for one, which was malignant. An average of three to five units of blood transfusion was required and mean operating time was 4.5 hours. Six patients had extensive intra-operative blood pressure (BP) fluctuation, but were adequately managed by the anesthetic team. One patient with post-operative pulmonary edema died in our series; rest all the patients are on regular follow-up, till date and doing well. Conclusion: Pheochromocytoma is an important cause of endocrine HT. Elevated urinary VMA is diagnostic of this tumor with imaging studies used to localize the tumor. Adrenalectomy results in complete cure of HT with an excellent long-term outcome.