PHEOCHROMOCYTOMA, CHRONIC RENAL-INSUFFICIENCY, AND HEMODIALYSIS - A COMBINATION LEADING TO A DIAGNOSTIC AND THERAPEUTIC DILEMMA

Pheochromocytomas are functioning paragangliomas often presenting with paroxysmal hypertension due to catecholamine secretion. The preferent ial diagnostic workup includes urine and serum catecholamine measureme nts. Therapeutic management consists of pharmacologic cardiovascular m anipulation and volume expansion with subsequent surgical resection. W e have encountered a symptomatic pheochromocytoma in a chronic renal i nsufficiency patient on hemodialysis. The diagnostic dilemma arose due to the patient's anuric status and the inherent increase in serum cat echolamine levels noted in anuric patients. The therapeutic dilemma ar ose in the proper pharmacologic management and volume expansion in thi s patient on hemodialysis. The patient underwent successful resection of the pheochromocytoma and has done well. An analysis of our diagnost ic and therapeutic processes as well as a review of the literature are presented to assist in the management of this difficult clinical situ ation.