title: Pheochromocytoma crisis is not a surgical emergency.
abstract: BACKGROUND
  Pheochromocytoma crisis is a feared and potentially lethal complication of pheochromocytoma.
  
  
  OBJECTIVE
  We sought to determine the best treatment strategy for pheochromocytoma crisis patients and hypothesized that emergency resection is not indicated.
  
  
  METHODS
  Retrospective cohort study (1993-2011); literature review (1944-2011).
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  There were 137 pheochromocytoma patients from our center and 97 pheochromocytoma crisis patients who underwent adrenalectomy from the literature.
  
  
  METHODS
  Medical management of pheochromocytoma crisis; adrenalectomy.
  
  
  METHODS
  Perioperative complications, conversion, and mortality.
  
  
  RESULTS
  In our database, 25 patients (18%) presented with crisis. After medical stabilization and α-blockade, 15 patients were discharged and readmitted for elective surgery and 10 patients were operated on urgently during the same hospitalization. None underwent emergency surgery. Postoperatively, patients who underwent elective surgery had shorter hospital stays (1.7 vs 5.7 d, P = 0.001) and fewer postoperative complications (1 of 15 [7%] vs 5 of 10 [50%], P = 0.045) and were less often admitted to the intensive care unit (1 of 15 [7%] vs 5 of 10 [50%], P = 0.045) in comparison with urgently operated patients. There was no mortality. Review of the literature (n = 97) showed that crisis patients who underwent elective or urgent surgery vs emergency surgery had less intraoperative (13 of 31 [42%] vs 20 of 25 [80%], P < 0.001) and postoperative complications (15 of 45 [33%] vs 15 of 21 [71%], P = 0.047) and a lower mortality (0 of 64 vs 6 of 33 [18%], P = 0.002).
  
  
  CONCLUSIONS
  Management of patients presenting with pheochromocytoma crisis should include initial stabilization of the acute crisis followed by sufficient α-blockade before surgery. Emergency resection of pheochromocytoma is associated with high surgical morbidity and mortality.
authors.affiliation: Section of Endocrine Surgery, University of California, San Francisco, California 94143, USA.
authors.forename: Anouk
authors.initials: A
authors.lastname: Scholten
authors.forename: Robin M
authors.initials: RM
authors.lastname: Cisco
authors.forename: Menno R
authors.initials: MR
authors.lastname: Vriens
authors.forename: Jenny K
authors.initials: JK
authors.lastname: Cohen
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Mitmaker
authors.forename: Chienying
authors.initials: C
authors.lastname: Liu
authors.forename: J Blake
authors.initials: JB
authors.lastname: Tyrrell
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D000315:Adrenalectomy; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010643:Phenoxybenzamine / Q000627:therapeutic use*; D010673:Pheochromocytoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D010643:Phenoxybenzamine