PHEOCHROMOCYTOMA: DIAGNOSIS AND TREATMENT

Abstract

These rare tumors of the chro-maffin system give symptoms when they secrete an excess of epinephrine and/or norepinephrine either intermittently or continuously. The symptoms are the result of the action of these secretions. Tumors have been found with the following symptoms:[long dash](1) A symptom-free individual with a tumor discovered accidently or at autopsy; (2) a symptom-free individual with sudden death following a minor trauma, frequently a surgical operation and the tumor discovered on autopsy; (3) the adrenal sympathetic syndrome (a) with usually a normal blood pressure but with intervals of paroxysmal hypertension, or (b) a continuous hypertension with paroxysmal rises; (4) a continuous hypertension simulating an essential or malignant hypertension. The diagnosis depends upon the following- -(a) a typical attack and associated clinical findings, (b) demonstration in the blood of a pressor substance, epinephrine, in a syndrome case, (c) the showing of a significant reduction of the blood pressure in a hypertensive state, either continuously or paroxysmally by an epinephrine antagonist such as benzodioxane or with dibenamine, (d) precipitation of an attack of hypertension in a resting stage case by an epinephrine secretion provocative such as histamine or mecholyl, (e) roentgenographic evidence of the presence of a tumor either within or without the adrenal as shown without or with air insufflation or by renal displacement as shown with pyelographic media. The treatment is surgical removal of the tumor or tumors. The recommended approach is transperitoneal with transverse incision. Control of the dangerous handling of the tumor may be by use of the androlytics, benzodioxane ro dibenamine in suitable doses. The danger is at the time of operation. There may be need of adrenal hormonal substitution therapy in the convalescent stage. Operative removal of all the tumor tissue is followed by cure.