CA: A Cancer Journal for Clinicians, Vol 19, 306-311, Copyright
© 1969 by American Cancer Society
Pheochromocytoma: 1. Specificity of Laboratory Diagnostic Tests. 2. Safeguards During Operative Removal
D. Pertsemlidis M.D.,
S. E. Gitlow M.D.,
W. C. Siegel, M.D., and
A. E. Kark M.D.
1. Every patient with hypertension, paroxysmal symptomatology, hypermetabolic state (without laboratory evidence of hyperthyroidism), a neurocutaneous syndrome, a familial history of pheochromocytoma or paroxysmal blood pressure change following trauma, surgery or childbirth, should be evaluated by assay of their VMA and/or combined metanephrine excretion.
2. Diagnostic tests which depend on the production of paroxysmal changes in blood pressure and procedures associated with even minor trauma should be avoided.
3. The demonstration of high VMA and combined metanephrine excretion (See Tables in source Pdf) in separate urine samples is an indication for laparotomy, if the chest X-rays are normal and no neck mass is present.
4. Phentolamine given in appropriate concentrations and without delay is highly effective in controlling hypertensive crises preoperatively, during the induction of anesthesia and operation.
5. Expansion of the circulating blood volume should begin with the skin incision and increased appropriately at the time of the interruption of the venous efflux from the tumor. The need for vasopressor drugs may thus be eliminated.
6. A meticulous search for multiple tumors through an anterior abdominal approach should be undertaken in all patients, particularly in children and familial cases.
