PRESENT-DAY DIAGNOSIS AND TREATMENT OF PHEOCHROMOCYTOMA

Abstract

• The histories of 50 patients who were found to have pheochromocytomas have been analyzed in order to identify factors that might be important in diagnosis and prognosis. The hypertension characteristic of pheochromocytoma was paroxysmal in 26 and persistent in 24. The tumors are usually benign, but eight in this series were malignant, and seven of the malignant type occurred in the cases of persistent hypertension. Tests for pheochromocytoma should be carried out on patients who complain of spells of severe headache of unexplained cause with perspiration, thoracic and abdominal pain, and nervousness and on any hypertensive patient who is thin and young, who has hypermetabolism without other signs of hyperthyroidism, who give a paradoxical reaction to ganglion-blocking agents, and who responds to anesthetics with a blood pressure rise. The tests consist of the administration of histamine base, tetraethyl-ammonium chloride, phentolamine, or piperoxan and determinations of plasma pressoramines under certain standard conditions. For removal of the tumor a transverse upper abdominal incision is recommended because it gives access to both adrenals and permits the inspection of the abdomen for aberrant masses of adrenal tissue, which are especially likely to occur in the region of the great vessels in the abdomen and about the base of the mesentery of the small intestine. During operation constant attention to the blood pressure is necessary because the pressure often rises sharply when the tumor is handled and falls to dangerously low levels when the tumor is removed. When recurrences or metastases are encountered, it is still possible to prolong the life of the patient by surgery or roentgenotherapy.