Surgery

Surgical resection (i.e., adrenalectomy) is the definitive treatment for patients with localized pheochromocytoma. A minimally invasive adrenalectomy is generally the preferred approach if the following conditions can be met:

Both anterior transabdominal laparoscopic adrenalectomy and posterior retroperitoneoscopic adrenalectomy have been demonstrated to be safe for most patients with a modestly sized, radiographically benign pheochromocytoma.[1,2] If preoperative imaging suggests malignancy, or if the patient has an extra-adrenal paraganglioma or multifocal disease, an open approach is generally preferred.

Intraoperative hypertension can be controlled with intravenous infusion of phentolamine, sodium nitroprusside, or a short-acting calcium-channel blocker (e.g., nicardipine). Tumor removal may be followed by a sudden drop in blood pressure that may require rapid volume replacement and intravenous vasoconstrictors (e.g., norepinephrine or phenylephrine). Postoperatively, patients should remain in a monitored environment for 24 hours. Postoperative hypotension is managed primarily by volume expansion, and postoperative hypertension usually responds to diuretics.