Treatment of pheochromocytoma (chromaffinoma)

The most effective and radical method of treating pheochromocytoma (catecholamine-producing tumors) is surgical. During preoperative preparation, the focus should be on prevention and management of hypertensive crises. For this, preparations of the alpha and beta-blocking series are used, such as tropafen, phentolamine, trasicor, trandate, dibenilin, praziol, obzidan, inderal. However, a complete blockade of adrenergic structures is almost impossible. Nevertheless, with the available choice of pharmacological agents, almost every patient can choose the most optimal drug for him, which allows to significantly reduce the frequency, severity or duration of catecholamine seizures. Another important aspect of preoperative preparation is the compensation of violations of carbohydrate metabolism and the treatment of the corresponding chromaffinoma of angioretinopathy.

The most convenient access to the adrenal glands is the lumbotomy extraperitoneal with resection of the XI or XII ribs and the separation of the pleural sinus. Such an intervention is used in the presence of accurate data on the localization of the neoplasm in one or another adrenal. Bilateral adrenal lesions or suspicion of it involves longitudinal or transverse laparotomy, which allows you to examine not only the area of the adrenal glands, but also the places of possible localization of the chromaffinoma in the abdominal cavity, which must always be taken into account in the multiple nature of the tumor process. Fehromocyte must be removed together with the adrenal tissue remnants. With the likelihood of a metastatic process in the regional lymph nodes, the retroperitoneal tissue of the corresponding side is also removed.

So far, the question of the expediency of removing the primary focus in the presence of distant metastases or partial removal of the tumor remains unreasonable if technical intervention is not feasible. Advocates of the greatest possible elimination of tumor tissue believe that palliative surgery extends life to a considerable extent to patients, since chromaffinoma is considered to be a slowly growing tumor, and the current state of pharmacology makes it possible to significantly change the character 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.

A radically performed surgical intervention leads in most patients to almost complete recovery. The recurrence of the disease is 12.5%. The main condition for the early detection of chromaffinoma is the annual (at least in the next five years after the operation) carrying out a provocative test with histamine and compulsory examination of the 3-hour excretion of catecholamines and vanillylmandelic acid after it. The most common recurrence of chromaffinoma is observed in patients previously operated for a multiple, ectopic tumor, with chromaffinoma exceeding 10 cm in diameter, with violation during the intervention of the integrity of the capsule of the neoplasm, as well as in the family form of the disease.

Radiation therapy of tumors from chromaffin cells is ineffective. Currently, chemotherapeutic agents are not known, the use of which would give a satisfactory result.