Pheochromocytoma: Diagnosis, operative experiences and clinical results

Abstract

The need for careful clinical evaluation of all hypertensive patients is stressed. Certain signs, symptoms and findings that should be helpful in the diagnosis of pheochromocytoma are enumerated and discussed. Specifically, attention is directed to the importance of excessive perspiration, vasomotor phenomena, elevated body temperature, normal cold pressor response, postural hypotension and/or tachycardia, gastrointestinal symptoms, weight loss, glucose intolerance and glycosuria, hypermetabolism and paroxysmal attacks of hypertension as aids in the diagnosis of this surgically curable disease. These data are readily available and safe and require no unusual facilities. Pharmacologic tests with emphasis on the histamine and Regitine tests as the only important ones are discussed. The importance of determination of urinary and plasma catecholamine excretion and 3-methoxy, 4-hydroxy mandelic acid (VMA) is emphasized. Certain supplementary studies are briefly presented. The generally favorable results of surgical treatment of pheochromocytomas express the need for early diagnosis. Although usually pathologically benign, this tumor is physiologically malignant causing, without diagnosis and surgery, almost always serious disability or death. Thirteen of twenty operative survivors have normal blood pressure 37 to 247 months postoperatively. Six continued to have mild hypertension which required medical supervision. One patient was lost to long-term follow-up study. No new or second tumors have been found as yet in the patients with residual hypertension.