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Treatment of pheochromocytoma (chromaffinoma)
Last reviewed: 06.07.2025
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The most effective and radical method of treating pheochromocytoma (catecholamine-producing tumors) is surgical. During preoperative preparation, the main attention should be focused on the prevention and relief of hypertensive crises. For this purpose, alpha- and beta-blocking drugs are used, such as tropafen, phentolamine, trazicor, trandate, dibenilin, pratsiol, obzidan, inderal. However, complete blockade of adrenergic structures is almost impossible. Nevertheless, with the available choice of pharmacological agents, almost every patient can be given the most optimal drug, which allows to significantly reduce the frequency, severity or duration of catecholamine attacks. Another important aspect of preoperative preparation is compensation for carbohydrate metabolism disorders and treatment of angioretinopathy corresponding to chromaffinoma.
The most convenient approach to the adrenal glands is lumbotomy extraperitoneal with resection of the 11th or 12th ribs and separation of the pleural sinus. Such intervention is used if there is precise data on the localization of the neoplasm in one or another adrenal gland. Bilateral adrenal gland damage or suspicion of it requires longitudinal or transverse laparotomy, which allows examining not only the adrenal gland area, but also the possible locations of chromaffinoma in the abdominal cavity, which must always be taken into account in the case of multiple tumor processes. Phechromocytoma must be removed together with the remnants of the adrenal gland tissue. If there is a possibility of a metastatic process in the regional lymph nodes, the retroperitoneal tissue of the corresponding side must also be removed.
The question of the advisability of removing the primary lesion in the presence of distant metastases or partial removal of the tumor when radical intervention is technically impossible remains controversial. Supporters of the maximum possible removal of tumor tissue believe that palliative surgeries significantly prolong the lives of patients, since chromaffinoma is considered a slowly growing tumor, and the current state of pharmacology allows for a significant change in the nature of the clinical manifestations of the disease. At the same time, the authors rightly believe that the best drug effect is achieved much more easily with a smaller mass of functioning tumor tissue.
Radical surgical intervention leads to almost complete recovery in most patients. Relapse of the disease is 12.5%. The main condition for early detection of chromaffinoma is an annual (at least in the next 5 years after the operation) provocative test with histamine and mandatory study of 3-hour excretion of catecholamines and vanillylmandelic acid after it. Most often, relapse of chromaffinoma is observed in patients previously operated on for multiple, ectopic tumors, with chromaffinoma exceeding 10 cm in diameter, with a violation of the integrity of the neoplasm capsule during the intervention, as well as in the familial form of the disease.
Radiation therapy for chromaffin cell tumors is ineffective. There are currently no known chemotherapeutic agents that would provide satisfactory results.