Pheochromocytoma

Clive S. Grant, MD

...in the right adrenal gland a tumor was palpable... the patient's blood pressure had been running at a normal level, perhaps 150 systolic. She almost immediately then went into cardiac arrest. Cardiac massage through the diaphragm was not effective and accordingly after this was tried for thirty or forty seconds the chest was opened and inside another thirty or forty seconds, I did feel a satisfactory beat was established. As soon as the heart began to beat again, the blood pressure was very high being well over 250 We proceeded with the operation and with some difficulty from bleeding and exposure, removed the pheochromocytomas from the right side As soon as the tumor was removed on this side, the bottom fell out of the patient's blood pressure and she required a triple amount of Levophed to maintain her pressure at 100 mm Hg.

From the operative note on a patient operated by Dr. Priestley in August 1961. The patient survived and recovered well.

From a surgeon's perspective, the ultimate surgical challenge might be characterized as one that requires careful thought and preparation preoperatively, a technically challenging operative procedure in the presence of risk and pressure, and the gratification that follows when the tumor has been successfully excised and the patient can be reassured that the tumor, which may have posed even life-threatening risk, has been removed and he or she is cured. In every regard, the surgical excision of a pheochromocytoma fulfills these criteria. To achieve a successful outcome requires specific knowledge and careful attention to detail throughout the entire course of the patient's management. Patients look to surgeons as the key individuals in the overall management of this tumor. However, to accept this role responsibly requires a team effort with close interaction with the endocrinologist, radiologist, and anesthesiologist, who play integral parts in the patient's care. This central leadership role of the surgeon requires an understanding of all facets of the care.

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