Initially, an attempt should be made to remove the pheochromocytoma laparoscopically (by laparoscopy), i.e., minimally invasively. This procedure can be used in the majority of cases. If this is not possible, for example, because of the tumor size or because it is difficult to access, invasive surgery will be required:
- Unilateral adrenalectomy (removal of the affected adrenal gland) – for unilateral (unilateral) pheochromocytoma.
- Bilateral subtotal (organ-preserving) adrenalectomy – for MEN 2 syndrome.
- Bilateral subtotal adrenalectomy – for bilateral (bilateral) pheochromocytoma.
In unilateral pheochromocytoma, the healthy adrenal gland is sufficient for hormone production. If both adrenal glands are removed, steroid hormones and catecholamines must be substituted for life.
The following should be noted:
- “No touch” technique – to prevent release of catecholamines.
- Preoperative blockade of alpha receptors (phenoxybenzamine; see “Drug therapy”) – 10 days before surgery; for tachyarrhythmias (the heart beats too fast and irregularly) in combination with beta blockers
- Preoperative volume replenishment – for prophylaxis of a postoperative drop in blood pressure.
- Postoperatively: watch for hypoglycemia (low blood sugar) as well as blood pressure drop
- In the first 5 years, regular hormone checks must be observed: after 3, 6, 12 months and then every 1-2 years.
If the patient can not be operated, drug therapy is given for the purpose of normalization of blood pressure or prevention of hypertensive crises (hypertension crises) (see there).
