PHAEOCHROMOCYTOMA CURED BY SURGICAL INTERVENTION. CLINICAL MANAGEMENT. ANALYSIS OF ALL REPORTED OPERATED CASES

Abstract

A case of phaeochromocytoma involving the right adrenal gland, and having a typical history of hypertensive paroxysms, a palpable mass, and characteristic roentgenograms, in which surgical removal was successful is discussed. A remarkable feature is the progressive disappearance of the severe changes in the optic fundi and a return to normal of the dextrose tolerance test after removal of the tumor. It was found necessary to use epinephrine in addition to the usual treatment for postoperative shock, especially to combat the sudden collapse during and immediately following surgery. The use of desoxycorticosterone acetate and adrenal cortex extract definitely lessened the severe postoperative hypo-tensive crisis. A rationale was presented as a basis for the preoperative and postoperative use of these 2 substances. The literature was reviewed with an analysis and tabulation of the 30 cases in which the tumor was attacked surgically. Intraven. pyelography helped localize the tumor in 4 cases, gave questionable evidence in 3 cases, but no evidence in 7 cases. Retrograde pyelography gave positive localizing evidence in 9, but no evidence in 4 cases. Perirenal pneumo-grams gave positive localizing evidence in 4 of 5 cases in which it was attempted. Of these 30 operative cases, postoperative shock was reported in 18 and the 4 deaths that occurred immediately following the operation were in this group. One patient died of pneumonia: one, of metastases, the only malignant tumor in this series; and 2 patients had a return of symptoms or blood pressure variations.