How to treat pheochromocytoma, conservative treatment is best

Pheochromocytoma is a benign tumor that originates from the chromaffin tissue of the neuroectoderm. However, some patients may suffer from severe heart, brain, and kidney damage due to long-term hypertension or may suffer from crisis due to sudden severe hypertension, which is life-threatening. However, if it can be diagnosed and treated in a timely and early manner, it is a curable secondary hypertension disease.

1. Medication

(1) Once the qualitative and localized diagnosis of pheochromocytoma is confirmed, medication should be used immediately to control the condition to prevent hypertensive emergencies. The main drugs used are long-acting α-receptor blockers, including phenoxybenzamine and prazosin.

(2) Phentolamine can be given intravenously when combined with hypertensive emergencies. If the treatment is ineffective, sodium nitroprusside can be infused intravenously.

2. Preoperative preparation and drug treatment

(1) α-adrenergic receptor blockers ① Phentolamine: used for differential diagnosis of hypertension, treatment of dangerous hypertension attacks or control of blood pressure during surgery. ② Phenoxybenzamine: Commonly used in preoperative preparation, taken orally before surgery until blood pressure is close to normal. Changes in blood pressure and heart rate in supine and standing positions should be closely monitored during medication. ③ Prazosin, terazosin, and doxazosin: all are selective postsynaptic α1-adrenergic receptor blockers. It can easily cause severe orthostatic hypotension when used, so it should be taken before bedtime and stay in bed as much as possible. ④ Urapidil (Urapidil): It can block α1 and α2 receptors, activate central serotonin 1A receptors, reduce the sympathetic feedback of the medullary cardiovascular regulation center, and thus lower blood pressure without increasing heart rate.

(2) β-adrenergic receptor blockers: After using α-receptor blockers, the excitability of β-receptors is enhanced, causing tachycardia, increased myocardial contractility, and increased myocardial oxygen consumption. β-blockers should be used to improve symptoms.

(3) Calcium channel blockers (CCBs) CCBs can be used for preoperative combined treatment, especially for patients with coronary heart disease or catecholamine cardiomyopathy, or used in combination with α- and β-receptor blockers for long-term antihypertensive treatment. Nifedipine is commonly used.

(4) Angiotensin-converting enzyme inhibitors (ACEI) such as captopril.

(5) Vasodilator Sodium nitroprusside is a powerful vasodilator, mainly used for patients with pheochromocytoma experiencing hypertensive crisis or with persistently elevated blood pressure during surgery. Closely monitor blood pressure, adjust drug dosages to prevent a sudden drop in blood pressure, and monitor blood cyanide levels.

(6) Catecholamine synthesis inhibitor α-Methyl-p-tyrosine is a competitive inhibitor of tyrosine hydroxylase, blocking catecholamine synthesis. The dose can be adjusted according to blood pressure and blood and urine catecholamine levels and can be increased gradually. Common side effects include drowsiness, depression, gastrointestinal symptoms, and extrapyramidal symptoms such as Parkinson's disease. The above symptoms may disappear quickly after reducing the dosage or stopping the medication.

3.131Ⅰ-MIBG treatment

It is mainly used for malignant and surgically unresectable pheochromocytoma.