Pheochromocytoma in the modern context.

The hypertensive patient faces an uncertain future. Therefore a search for those cases in which the condition is potentially curable is eminently worth while and has become increasingly productive because of the specific diagnostic aids now available and because of the present safety of surgical intervention. Detection and localization of a pheochromocytoma allows a planned surgical approach. Correction of hypovolemia preoperatively ensures a safe course postoperatively. The use of blocking agents pre- and peroperatively prevents the hazardous hypertensive crises and arrhythmias that were a part of early surgical experience. Monitoring of central venous and arterial pressures as well as the electrocardiographic tracing during the operation permits prophylactic therapy when necessary. On the basis of a series of 31 patients the authors compare many aspects of the current management with earlier experience of pheochromocytoma in the same institution. The incidence of extra-adrenal lesions (3.8%), multicentric tumours (3.8%) and malignant change (11.5%) was lower in this group of patients than that usually reported. Abdominal exploration remains the approach of choice in most cases. Treatment of the solitary pheochromocytoma has become straightforward. However, management of the familial syndromes and the malignant from of the disease still requires careful scrutiny.