Pheochromocytoma crisis is not a surgical emergency

Abstract

Context: Pheochromocytoma crisis is a feared and potentially lethal complication of pheochromocytoma. Objective: We sought to determine the best treatment strategy for pheochromocytoma crisis patients and hypothesized that emergency resection is not indicated. Design: Retrospective cohort study (1993-2011); literature review (1944-2011). Setting: Tertiary referral center. Patients: There were 137 pheochromocytoma patients from our center and 97 pheochromocytoma crisis patients who underwent adrenalectomy from the literature. Intervention: Medical management of pheochromocytoma crisis; adrenalectomy. Main Outcome Measure(s): Perioperative complications, conversion, and mortality. Results: In our database, 25 patients (18%) presented with crisis. After medical stabilization and α-blockade, 15 patients were discharged and readmitted for elective surgery and 10 patients were operated on urgently during the same hospitalization. None underwent emergency surgery. Postoperatively, patients who underwent elective surgery had shorter hospital stays (1.7 vs 5.7 d, P = 0.001) and fewer postoperative complications (1 of 15 [7%] vs 5 of 10 [50%], P = 0.045) and were less often admittedto the intensive care unit (1 of15[7%]vs5of10[50%],P = 0.045) in comparison with urgently operated patients. There was no mortality. Review of the literature (n = 97) showed that crisis patients who underwent elective or urgent surgery vs emergency surgery had less intraoperative (13 of31 [42%] vs 20 of 25 [80%], P < 0.001) and postoperative complications (15 of 45 [33%] vs 15 of 21 [71%], P = 0.047) and a lower mortality (0 of 64 vs 6 of 33 [18%], P = 0.002). Conclusions: Management of patients presenting with pheochromocytoma crisis should include initial stabilization of the acute crisis followed by sufficient α-blockade before surgery. Emergency resection of pheochromocytoma is associated with high surgical morbidity and mortality. Copyright © 2013 by The Endocrine Society.