How to treat adrenal pheochromocytoma

The harm caused by adrenergic pheochromocytoma is relatively large, especially malignant pheochromocytoma. Treatment must be carried out as soon as possible to reduce its impact, including surgical treatment, and it can also be combined with chemotherapy such as vincristine and dacarbazine.

1. Treatment of hypertensive crisis caused by pheochromocytoma

The head of the bed should be elevated first, and phentolamine should be injected intravenously immediately. Observe blood pressure closely and stop injection when it drops to around 160/100 mmHg. Followed by slow drip.

2. Postoperative treatment

After the tumor was removed, the patient's blood pressure dropped rapidly. If persistent hypertension persists after surgery, it may be that the tumor has not been completely removed or is accompanied by primary hypertension or renal hypertension. Catecholamines return to normal levels 7 to 10 days after surgery. Therefore, catecholamines or their metabolites should be measured 1 week after surgery to determine whether the tumor has been completely removed.

For patients who cannot undergo surgery or whose malignant tumors have spread, long-term drug treatment can be used. Most tumors grow slowly. Long-term treatment with adrenergic receptor blockers and α-methyltyrosine can effectively inhibit catecholamine synthesis.

3. Treatment of malignant pheochromocytoma

Malignant pheochromocytoma may recur in the retroperitoneum or metastasize to the bones, lungs, liver, etc. Recurrence may occur several years or even decades after the first surgery, requiring long-term follow-up observation. Although radiotherapy is not very effective, it is beneficial for controlling bone metastasis. Cyclophosphamide, vincristine, and dacarbazine (dacarbazine) can be used in combination for chemotherapy.

4. Management of familial pheochromocytoma

Familial pheochromocytomas are often multiple or involve both adrenal glands and have a high recurrence rate. Available options include follow-up observation for small, nonfunctional tumors, adrenalectomy on the tumor side, and prophylactic bilateral adrenalectomy. Long-term corticosteroid replacement therapy should be considered after bilateral adrenalectomy.

5. Management of pheochromocytoma during pregnancy

Pheochromocytoma during pregnancy is difficult to manage. Vaginal delivery without any preparation often brings great harm to the mother and baby. MRI is suitable for localization of the tumor. Once the diagnosis is made, alpha-blockers should be taken to control symptoms. If the pregnancy is in the early or middle stages, surgery should be performed immediately after adequate preoperative preparation. There is no need to terminate the pregnancy after surgery, but surgery may increase the risk of miscarriage. If the diagnosis is made late in pregnancy, cesarean section can be performed at term along with surgery for pheochromocytoma. If the fetus is not yet mature, the patient should continue to take medication and be closely monitored until surgery is appropriate.