Preoperative management of the pheochromocytoma patient.
Pheochromocytomas are rare neuroendocrine tumors with a highly variable clinical presentation, but they most commonly present as spells of headaches, sweating, palpitations, and hypertension. Patients with pheochromocytoma may develop complicated and potentially lethal cardiovascular and other complications, especially in the setting of diagnostic or interventional procedures (e.g. upon induction of anesthesia or during surgery). The serious and potentially lethal nature of such complications is due to the potent effect of paroxysmal release of catecholamines. Because this warrants prompt diagnosis and treatment, the physician should be aware of the clinical manifestations and complications of catecholamine excess and be able to provide proper preoperative management to minimize catecholamine-related pre-, intra-, and postoperative adverse events. The following clinical scenario and discussion aim to enhance the knowledge of the physician regarding the behavior of pheochromocytoma and to outline current approaches to comprehensive preoperative management of patients suffering from this tumor.
Pacak
Karel
K
Section on Medical Neuroendocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, Maryland 20892-1109, USA. karel@mail.nih.gov
D000310:Adrenal Gland Neoplasms / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D001810:Blood Volume / Q000502:physiology; D002395:Catecholamines / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010673:Pheochromocytoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D011300:Preoperative Care; D011941:Receptors, Adrenergic / Q000187:drug effects
D002395:Catecholamines; D011941:Receptors, Adrenergic