Pheochromocytoma coexisting with renal artery lesions

Purpose: Physiologically significant renal artery lesions in the presence o f a pheochromocytoma comprise a confounding factor which may impact on the hypertension cure following excision of the pheochromocytoma. We present 10 cases of these dual lesions and review the literature on this entity. Materials and Methods: From 1952 to 1999, 269 patients were diagnosed with pheochromocytoma at our institution. Hospital charts of these patients were reviewed retrospectively to identify those with coexisting renal artery st enosis. A Medline search was performed to review the available literature. Results: Of the 269 patients with pheochromocytoma 10 (3.7%) had coexisting renal artery lesions, including renal artery stenosis in 8, renal artery a neurysm in 1 and postangiographic dissection occlusion in 1. Pheochromocyto ma was adrenal in 8 cases and ectopic in 2. Of the patients 9 have been tre ated to date by adrenalectomy in 4, nephroadrenalectomy in 3, adrenalectomy plus lysis of renal artery adhesions in 1 and adrenalectomy plus renal aut otransplantation with bench repair in 1. Both lesions were diagnosed preope ratively in 9 cases and a hypovascular adrenal lesion was missed preoperati vely in i. A review of literature revealed a total of 87 cases of coexistin g pheochromocytoma and renal artery lesions. Conclusions: There are multiple mechanisms that can lead to renal artery st enosis and pheochromocytoma. A high index of suspicion is necessary to enab le both entities to be diagnosed preoperatively and allow proper planning o f surgical therapy. Incomplete diagnosis may lead to persistent hypertensio n postoperatively.