From the Guidelines
Pheochromocytoma is a rare adrenal tumor that requires immediate medical attention, and the definitive treatment is surgical removal of the tumor after adequate pharmacological preparation with alpha-blockers, such as doxazosin or terazosin, followed by beta-blockers, to control blood pressure and prevent fatal events. The symptoms of pheochromocytoma include episodes of high blood pressure, headaches, sweating, and heart palpitations, as well as anxiety, tremors, facial pallor, nausea, and weight loss [ 1 ]. Some patients may experience severe hypertensive crises that can be life-threatening, and adrenergic crises should be treated with an intravenous alpha-1-blocker, such as phentolamine, doxazosin, or terazosin, or labetalol [ 1 ].
Diagnosis and Treatment
The diagnosis of pheochromocytoma typically involves blood and urine tests to measure catecholamine levels, followed by imaging studies like CT scans or MRIs to locate the tumor [ 1 ]. The treatment options for pheochromocytoma include:
- Surgical removal of the tumor (adrenalectomy) after adequate pharmacological preparation with alpha-blockers, such as doxazosin or terazosin, followed by beta-blockers [ 1 ]
- Administering doxazosin or terazosin, followed by a beta-blocker, to control blood pressure and adrenergic crises [ 1 ]
- Using intravenous medications like phentolamine or labetalol during a hypertensive crisis [ 1 ]
Post-Surgical Care
After successful surgery, most symptoms of pheochromocytoma resolve, but patients require lifelong monitoring as the tumor can recur or be part of genetic syndromes [ 1 ]. Additionally, patients with pheochromocytoma have peripheral hypovolaemia, which exposes them to the risk of profound hypotension, particularly right after tumor excision, and therefore, adequate fluid administration should be carefully managed [ 1 ].
Key Considerations
It is essential to identify and screen for germline mutations, such as those involving succinate dehydrogenase B, as they can drive management of the proband and the family and inform the choice of functional imaging [ 1 ]. Furthermore, early definite surgical treatment of the pheochromocytoma should be a priority, especially in cases with documented life-threatening arrhythmias [ 1 ].
From the FDA Drug Label
Phenoxybenzamine hydrochloride capsules are indicated in the treatment of pheochromocytoma, to control episodes of hypertension and sweating. If tachycardia is excessive, it may be necessary to use a beta-blocking agent concomitantly. The symptoms of pheochromocytoma that are mentioned include:
- Hypertension
- Sweating
- Tachycardia The treatment options for pheochromocytoma include:
- Phenoxybenzamine to control episodes of hypertension and sweating
- Beta-blocking agent (if tachycardia is excessive) 2
From the Research
Symptoms of Pheochromocytoma
- The symptoms of pheochromocytoma are not explicitly mentioned in the provided studies, but it can be inferred that the disease is associated with high cardiovascular morbidity and mortality if left untreated 3.
- The disease is characterized by the secretion of catecholamines, which can lead to hypertensive crises and cardiac arrhythmias during surgery 3.
Treatment Options for Pheochromocytoma
- Surgical resection is the only curative therapy for pheochromocytoma 3, 4.
- Preoperative pharmacological management is crucial to reduce the risk of hypertensive crises and cardiac arrhythmias during surgery 3, 5.
- Alpha-blockers, such as phenoxybenzamine and doxazosin, are commonly used in the preoperative treatment of pheochromocytoma to control blood pressure and prevent hemodynamic instability 5.
- Minimally invasive endoscopic techniques, such as laparoscopic and retroperitonescopic adrenalectomy, have become widespread in the surgical treatment of pheochromocytoma 6.
- The standard volume of surgical intervention is total adrenalectomy, but cortical-sparing adrenalectomy may be considered in patients with hereditary syndromes 6.
- Treatment for malignant recurrences may include surgery, therapeutic embolization, chemotherapy, and the application of therapeutic doses of metaiodobenzylguanidine 7.
- Metyrosine, phenoxybenzamine, or somatostatin analogs may be used to control blood pressure and alleviate symptoms in patients with malignant pheochromocytoma, but these treatments have no antiproliferative effect 7.