medical preoperative management of pheochromocytoma

1. Management of Pheochromocytoma
Dr. Rupak Raj Ghimire
1st Year Surgery Resident

2. Treatment
complete resection of tumor
laparoscopic adrenalectomy is standard care
open adrenalectomy in cases of large or surgically difficult lesions
preoperative management is important

3. preoperative management
international symposium on pheochromocytoma (2005)
preoperative catecholamine blockade
cardiology or anesthesiology consultation prior to surgery

5. alpha blocked
Phenoxybenzamine:
most common
7-14 days before surgery
10mg BID upto 1mg/kg
in children 0.2mg/kg (max: 10mg) QID
Terazosin, Doxazosin or Prazosin can be used

6. Beta Blockade
for reflex tachycardia and arrhythmias
should never be started before appropriate alpha blockade

7. Catecholamine synthesis blockade
⍺-Methyltyrosine (Metyrosine)
blocks rate limiting step in biosynthesis of catecholamines
inhibit tyrosine hydroxylase

8. calcium channel blocker
lowers blood pressure
smooth muscle relaxation

9. Intravascular volume management
adequate hydration required
minimized potentially prolonged
hypotension after tumor resection

10. Open Adrenalectomy
transperitoneal and retroperitoneal approach
transperitoneal approach
anterior trans abdominal approach
thoracoabdominal approach
retroperitoneal approach
flank approach
posterior lubodorsal approach

11. flank retroperitoneal
lateral decubitus position

12. Post operatively
rebound hyperinsulinemia leading to hypoglycemia
hypotension