PHEOCHROMOCYTOMA, A RARE CAUSE OF HYPERTENSION - LONG-TERM FOLLOW-UP OF 55 SURGICALLY TREATED PATIENTS

Pheochromocytoma is a rare tumor that is found in only 0.1% of patient s with diastolic hypertension, We analyze the results of our experienc e in management of pheochromocytomas and long-term results of its surg ical treatment. From 1977 to 1996 we operated on 55 patients with a ph eochromocytoma: 29 males and 27 females with an average age of 41 year s (range 10-63 years). In 44 (80.0%) patients episodic hypertension or paroxysms were observed; 7 (12.7%) patients had permanent hypertensio n, and 4 (7.3%) had a normal arterial blood pressure (ABP). I-131/123- MIBG scintigraphy (33 patients) and magnetic resonance imaging (12 pat ients) showed 100% sensitivity and computed tomography (47 patients) 9 7.9% sensitivity. At operation five (9.1%) tumors were bilateral, five extraadrenal, and five multiple. In four (7.3%) patients an associati on with familial syndromes (three MEN-IIb, one von Recklinghausen dise ase) was observed. Five (9.1%) malignant tumors were discovered, and t wo patients are still alive 30 and 104 months after surgery, one of th em with relapse. In 43 (78.2%) patients we preferred a flank incision, and no intraoperative deaths occurred. Mean follow-up was 88 months ( 6-232 months) with recurrence in only 1 (2.0%) of 50 patients without malignancy. In patients with benign pheochromocytomas the recurrence r ate did not seem to be elevated in our series. Nevertheless, because t he lifelong follow-up requires only annual 24-hour urinary catecholami ne measurement (less than $40 per patient per year) and periodic ABP m easurements, it is suggested for all patients who undergo surgery for pheochromocytoma.