Pheochromocytoma Across the Perioperative Course: Current Concepts and Clinical Management
Abstract
Pheochromocytoma is an uncommon neuroendocrine tumor with myriad nonspecific clinical presentations. If not recognized and treated, it is associated with the development of target organ damage and complications such as myocarditis, cardiomyopathy, cerebrovascular accidents, and diabetes mellitus, among numerous others. The pheochromocytoma diagnosis is based on biochemical proof of catecholamine excess followed by imaging localization of the tumor. Patients with newly diagnosed pheochromocytoma should be seen by a multidisciplinary perioperative team, including the anesthesiologist, operating surgeon, endocrinologist, and cardiologist. Perioperative antihypertensive therapy should be instituted prior to adrenal resection to allow for cardiovascular recovery and to hopefully mitigate the hypertensive response to laryngoscopy and tumor manipulation. The anesthesiologist must be prepared to manage both intraoperative hypertension, hypotension, and glycemic disturbances, among other possible complications. Patients with previously undiagnosed pheochromocytoma who present for unrelated surgery represent a high-risk group. Once intraoperatively suspected, priority should be given to immediate stabilization, cessation of surgery when feasible, and close communication with the surgical team regarding whether the procedure should be aborted, limited, or continued based on the urgency of the operation and the patient's clinical status. In most cases, nonessential surgery should be…
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