Clinical eatures o pheochromocytoma and perioperative anesthetic

management
LIU Ailn CIU Xian,yan, YI |io BE^ Hon,zhi HIA^C Y,an,
and YE 1ioh
Keywors !"#$%"&$$%()$* %*)#%"$+*,-# *-#.)"#.,*
Ioparimoni ol Ano-iho-ia Pokin, Inion Hodical Collo,o Ho-piial
Boijin, 100730 China Lo AL Co XY Yi | Bon HZ Han,
YC and Yo 1H
Corro-pondonco io Ir. Lo Ailn Ioparimoni ol Ano-iho-ia
Pokin, Inion Hodical Collo,o Ho-piial Boijin, 100730 China
1ol 86-10-65295593. Iax 86-10-65295593. Email loailnC
phlic. pmch. ac. cn
Objectve To invetigate clinical feature of pheochromocytoma and ummarize experience of
anethetic management during the perioperative period.
Methods Two hundred and fifty eight patient who were diagnoed with pheochromocytoma in our
hopital were reviewed retropectively for clinical feature. According to different preoperative
pharmalogical preparation perioperative mortalitie were analyzed in three period Period 1
January 1955 December 1975 Period 2 January 1976 December 1994 Period 3 January 1995
July 2001 . n Period 3 hemodynamic change in the patient undergoing different anethetic
method were analyzed.
ResuIts About 5. 8% 15 258 of pheochromocytoma wa an integral part of multiple endocrine
neoplaia MEN type ! or mixed type. Sixty percent 149 249 of the patient who had undergone
urgery poeed evidence of catecholamine cardiac toxicity preoperatively. mpaired glucoe
tolerance wa found in 59% 147 249 of the patient before urgery. Perioperative mortality wa
ignificantly decreaed from 8% 5 60 in Period 1 to 1. 2% 1 75 in Period 2 P < 0. 01 . No
perioperative death occurred in Period 3. The volume infued during the operation wa ignificantly
higher both in the epidural anetheia group 3474 ml 624 ml P < 0. 01 and in the epidural plu
general anetheia group 3654 ml 475 ml P < 0. 01 than in the general anetheia group
2534 ml 512 ml . There were favorable hemodynamic characteritic in patient before removal of
the tumor in the epidural anetheia group and in the epidural plu general anetheia group a
compared with the general anetheia group.
ConcIusons A poitive urgical outcome of the exciion of pheochromocytoma depend on multiple
factor including careful aement of potential vital organ damage before urgery and retoration of
blood volume by etablihing "-blockade preoperatively meticulou anethetic management of
patient during urgery and appropriate circulatory upport after urgery.
C/in 1e ] 2003 116 10 1527-1531
Aliho,h -r,ical iroaimoni lor phoochromocyioma and
ii- porioporaiivo mana,omoni ha- hoon woll dovolopod in
roconi yoar- ano-ihoiic mana,omoni i- -iill hi,hly
-iro--ll in coriain circm-ianco- -ch a- cooxi-ioni
ondocrino imor- occli phoochromocyioma and
cardiova-clar impairmoni.
1-3
1ho prpo-o ol ihi- -idy
wa- io invo-ii,aio iho clinical loairo- ol phoochromo-
cyioma and -mmarizo iho oxporionco- ol ano-ihoiic
mana,omoni in iho porioporaiivo poriod.
METHODS
A roiro-pociivo roviow wa- condciod in iho paiioni- who
woro clinically or paiholo,ically dia,no-od wiih
phoochromocyioma in or ho-piial hoiwoon |anary 1955
and |ly 2001.
General inormation
1ho lollowin, daia woro collociod domo,raphic- clinical
7 2 5 1 C/inese 1eico/ ]oucno/ 2003 116 10 1527-1531
and paihl,ical dia,n-i- ima,o oxaminaiin-
includin, ahdminal ulira-n,rapy C1 -can HBI
131
I-moia-idhonzyl,uanidino
131
I-HIBC hichomical
oxam-inaiin- and ihorapouiic -iraio,io-.
Periopertive mortlities in different periods
Accrdin, i dilloroni proporaiivo pharmacl,ical
proparaiin poriporaiivo mrialiiio- woro analyzod in
ihroo porid- Porid 1 |anuary 1955 Iocomhor 1975
Porid 2 |anuary 1976 Iocomhor 1994 Porid 3
|anuary 1995 |uly 2001 . In Porid 1 nly -odaiivo-
-uch a- honzdiazopino woro admini-iorod. In Porid 2
phonxyhonzamino an !-hlckor wa- ruiinoly
admini-iorod lr proporaiivo proparaiin which wa-
-moiimo- cmhinod wiih prpranll il iachycardia
ccurrod. In Porid 3 in addiiin i modicaiin-
admini-iorod in Porid 2 a docroa-o in proporaiivo
homaicrii hy 5% i,oihor wiih an incroa-o in hdy
woi,hi wa- appliod a- no l iho clinical markor- l
ro-irod hld vlumo. In ihi- porid urapidil and
o-mll woro clinically availahlo lr hih proporaiivo
proparaiin and iniraporaiivo aniihyporion-ivo a,oni-.
Chnges of hemodynmic prmeters during surgery
under different nesthesi
1ho ano-ihoiic chari- l iho paiioni- in Porid 3 woro
analyzod lr iniraporaiivo homdynamic chan,o-.
Accrdin, i ano-ihoiic chari- iho paiioni- woro dividod
ini ihroo ,rup- ,onoral ano-iho-ia opidural
ano-iho-ia and ,onoral plu- opidural ano-iho-ia ,rup-.
In iho ,onoral ano-iho-ia ,rup ano-iho-ia wa- inducod
wiih oiihor 5 m, k, -dium ihiponial r prpll l
1 m, k, 2m, k, i. v. lllwod hy 1 m, k, 2 m, k,
-uccinylchlino i laciliiaio ondirachoal iniuhaiin.
Ano-iho-ia wa- mainiainod wiih inhalaiin l i-llurano r
onllurano and niiru- xido in xy,on niiru- xido
xy,on = 2 1 -upplomoniod wiih lonianyl injociin
iniormiiionily. Hu-clo rolaxaiin durin, iho poraiin wa-
mainiainod wiih iniormiiioni hlu-o- l pancurnium r
vocurnium. In iho opidural ano-iho-ia ,rup a caihoior
wa- in-oriod ini opidural -paco hoiwoon 1
10
and 1
11
undor lcal ano-iho-ia. A mixiuro l 1% xylcaino and
0. 25% ioiracaino wa- u-od and iho hlckod lovol wa-
adju-iod alior 5 ml io-iin, d-o. Iurin, opidural
ano-iho-ia iho paiioni- woro -odaiod wiih iniravonu-
injociin l diazopam r midazlam.
1ho lllwin, daia woro cllociod and analyzod -ur,ical
prcoduro- ano-ihoiic moihd- and iniraporaiivo
inva-ivo homdynamic paramoior- includin, pulmnary
ariory wod,o pro--uro PAVP ri,hi airial pro--uro
BAP -y-iomic va-cular ro-i-ianco S\B cardiac
indox CI loli voniricular -irko wrk indox
L\SVI and moan ariorial hld pro--uro HAP .
Bld l-- and inlu-od lluid vlumo porconia,o l
admini-iraiin l va-dilair- and inirpic- durin,
-ur,ory woro al- rocrdod.
Sttisticl nlysis
Homdynamic paramoior- durin, iho -ur,ory woro
analyzod wiih analy-i- l varianco. Porconia,o- l
admini-iorin, cardiva-cular a,oni- durin, iho -ur,ory
and poriporaiivo mrialiiio- in dilloroni porid- woro
analyzod wiih "
2
io-i. All daia woro oxpro--od a- moan
SI. A P valuo lo-- ihan 0. 05 wa- cn-idorod -iaii-iically
-i,nilicani.
RESULTS
Generl informtion
1ho paiioni- a,o ran,od lrm 7 i 70 yoar- moan 35
yoar- . Halo paiioni- woro 159 and lomalo paiioni- woro
99. 1ho duraiin l iho di-oa-o wa- lrm 20 day- i 15
yoar- avora,o 2 yoar- . Phochr-mcyima- woro
lcaiod in iho modulla l iho adronal ,land in 87%
224 258 l iho paiioni- and ui-ido iho adronal ,land
in 13% 34 258 l iho paiioni-. H-i phochrm-
cyima- 76% 206 258 -ocroiod nropinophrino oiihor
alno r mro cmmnly cmhinod wiih opinophrino.
Ahui 15% 39 258 l iho phochrmcyima-
-ocroiod prodminanily opinophrino. 1ho romainin, 9%
23 258 l iho phochrmcyima- woro a-ympimaiic
and incidonially idoniiliod durin, ruiino hoalih
oxaminaiin- r in iho cur-o l iroaimoni lr ihor
di-oa-o-.
Ahui 5. 8% 15 258 l phochrmcyima- wa-
pro-oniod a- a pari l muliiplo ondcrino nopla-ia-
HE^ . Elovon paiioni- pro-oniod wiih HE^ iypo #a
Sipplo -yndrmo iho main cn-iiiuoni- l which woro
modullary ihyrid carcinma hyporparaihyridi-m and
phochrmcyima no pro-oniod wiih HE^ iypo #h
includin, modullary ihyrid carcinma phochrm-
cyima and muc-al nourma- and ihroo pro-oniod wiih
mixod HE^ which cn-i-iod l phochrmcyima and
HE^ iypo $ Vormor - -yndrmo includin,
pancroaiic i-loi-coll iumr and hyporpla-ia r nopla-ia l
iho piiuiiary and paraihyrid ,land-.
Exci-in- l phochrmcyima- woro porlrmod in 249
paiioni-. 1ho -ur,ical prcoduro- includod unilaioral
ahdminal adronalocimy 212 ca-o- hilaioral
ahdminal adronalocimy 7 ca-o- and romval l
ocipic ahdminal phochrmcyima 30 ca-o- . 1ho
romainin, 9 inporahlo paiioni- undorwoni chomihorapy
8 2 5 1 C/inee 1edico/ ]oucno/ 2003 116 10 1527-1531
Table 1 Iluciuaion n homodynamc- holoro and alior iumor ro-ocion
Croup
BAP
mmH,
PAVP
mmH,
S\B
dyno -
-1
mn
-5

CI
L mn
-1
m
-2

L\SVI
dyno mn
-2

HAP
mmH,
Boloro iumor ro-ocion
C n =33 10. 8 3. 5 14. 2 2. 1 2284. 2 70. 2 5. 2 0. 8 75. 7 4. 2 132. 5 8. 5
E n =18 12. 1 2. 8 16. 4 2. 8 1975. 4 60. 7
!!
5. 4 0. 6 76. 8 7. 9 125. 4 12. 3
C + E n =15 12. 8 4. 3 15. 9 3. 7 1858. 5 49. 7
!!
5. 0 0. 4 73. 9 9. 3 120. 8 10. 5
Alior iumor ro-ocion
C n =33 8. 5 3. 4 13. 7 4. 7 1745. 8 60. 2
!
3. 1 0. 8
!
32. 5 9. 2
!
78. 3 9. 3
!
E n =18 9. 7 4. 0 12. 2 3. 6 1689. 9 81. 2
!
3. 7 0. 5
!
37. 4 8. 5
!
66. 6 4. 7
!
C + E n =15 9. 2 2. 3 11. 3 3. 6 1627. 7 60. 7
!
3. 3 0. 7
!
30. 7 5. 7
!
63. 8 8. 8
!
BAP r,hi airal pro--uro PAVP pulmonary arioral wod,o pro--uro S\BI -y-iomc va-cular ro--ianco ndox CI cardac ndox L\SVI loli vonircular
-iroko work ndox HAP moan arioral hlood pro--uro C ,onoral ano-iho-a ,roup E opdural ano-iho-a ,roup C + E ,onoral plu- opdural ano-iho-a
,roup. ! P <0. 01 comparod wih valuo- holoro iumor ro-ocion !! P <0. 01 comparod wih iho ,onoral ano-iho-a ,roup.
and nucloar ihorapy wih
131
I-HIBC.
Ahoui 60% 149 249 ol iho -ur,cal paioni- had
pro-oniaion- ol caiocholamno cardac ioxciy holoro iho
-ur,ory whch wa- manlo-iod a- ahnormal S1-1
-o,moni acuio myocardal nlarcion acuio pulmonary
odoma and cardomyopaihy. Cluco-o ioloranco io-i- woro
ahnormal n 59% 147 249 ol iho paioni- holoro iho
-ur,ory whlo i roiurnod io normal n 39% 97 249
paioni- po-ioporaivoly.
Perioperative mortalities in different periods
In Porod 1 iho poroporaivo morialiy wa- 8% 5 60 .
1ho cau-o- ol doaih woro con,o-ivo hoari laluro 2
paioni- myocardal nlarcion 1 paioni muliplo
or,an laluro 1 paioni or corohral homorrha,o
1 paioni . Howovor poroporaivo morialiy droppod
-,nlcanily io 1. 2% 1 78 P < 0. 01 n Porod 2.
1ho paioni dod ol muliplo or,an laluro alior a
complcaiod -ur,cal procoduro lor muliplo phoochromo-
cyioma- nvolvn, iho nloror vona cava. 1horo woro no
poroporaivo doaih- n Porod 3.
Changes of hemodynamic parameters during surgery
under different anesthesia
Sxiy--x ano-ihoic chari- wih comploio homodynamc
paramoior- woro -olociod lrom 111 chari- n Porod 3.
1ho h,ho-i homodynamc- holoro and iho lowo-i
homodynamc- alior iho ro-ocion ol iho iumor a- woll a-
iho amouni ol llud nlu-od niravonou-ly woro analyzod.
Sur,cal procoduro- lor oxc-on ol phoochromocyioma-
woro porlormod undor ,onoral ano-iho-a opdural
ano-iho-a or ,onoral ano-iho-a comhnod wih opdural
ano-iho-a n 33 18 and 15 ca-o- ro-pocivoly. Boloro
iumor ro-ocion hoih BAP and PAVP woro ai iho uppor
lmi- rro-pocivo ol iho lorm ol ano-ihoic moihod
-olociod. Howovor -,nlcanily loworod -y-iomc
va-cular ro--ianco wa- pro-oniod n iho opdural
ano-iho-a ,roup and iho opdural plu- ,onoral ano-iho-a
,roup. Alior romoval ol iho iumor ihoro wa- an ovorall
doclno n all homodynamc- n all iho ,roup- wih
-,nlcani docroa-o- n S\B CI L\SVI and HAP
1ahlo 1 . HAP wa- -,nlcanily h,hor n iho ,onoral
ano-iho-a ,roup ihan n iho oihor iwo ,roup- hoih holoro
and alior ro-ocion ol iho iumor.
Comparod wih iho ,onoral ano-iho-a ,roup iho
porconia,o ol u-n, va-odlaior- holoro iumor ro-ocion n
,onoral ano-iho-a ,roup wa- -,nlcanily h,hor ihan
iho-o n iho opdural and opdural plu- ,onoral ano-iho-a
,roup- 1ahlo 2 . Howovor ihoro wa- no -,nlcani
dlloronco n iho porconia,o ol caiocholamno
admn-iraiod amon, dlloroni ,roup- 1ahlo 3 .
1ho volumo -upplod durn, iho oporaion wa-
-,nlcanily h,hor hoih n iho opdural ano-iho-a ,roup
3474 ml 624 ml ncludn, Bn,or - -oluion 2500 ml
485 ml ,ololu-no 570 ml 110 ml and packod rod
hlood coll- 512 ml 72 ml P < 0. 01 and iho opdural
plu- ,onoral ano-iho-a ,roup 3654 ml 475 ml
ncludn, Bn,or - -oluion 2734 ml 318 ml ,ololu-no
627 ml 147 ml and packod rod hlood coll- 541 ml
91 ml P <0. 01 ihan iho ,onoral ano-iho-a ,roup
2534 ml 512 ml ncludn, Bn,or - -oluion 1874 ml
512 ml ,ololu-no 471 ml 107 ml and packod rod
hlood coll- 410 ml 70 ml .
Table 2 Porconia,o ol va-odlaior- admn-iorod holoro
iumor ro-ocion
Croup S^P Phoniolamno Irapdl E-molol
C n =33 73% 24 33
!
73% 23 33
!
12% 4 33 28% 9 33
E n =18 28% 5 18 37% 6 18
C + E n =15 27% 4 15 33% 5 15
S^P -odum niropru--do C ,onoral ano-iho-a ,roup E opdural
ano-iho-a ,roup C + E ,onoral plu- opdural ano-iho-a ,roup. ! P <
0. 01 comparod wih opdural ano-iho-a ,roup and opdural plu- ,onoral
ano-iho-a ,roup.
9 2 5 1 C/inee 1edico/ ]oucno/ 2003 116 10 1527-1531
Table 3 Porconi,o ol ciocholmino dmini-iorod lior
iumor ro-ociion
Croup Iopmino Adronlino ^ordronlino
C n =33 82% 27 33 9% 3 33 30% 10 33
E n =18 72% 13 18 6% 1 18 31% 5 18
C + E n =15 73% 11 15 7% 1 15 27% 4 15
C ,onorl no-iho-i ,roup E opidurl no-iho-i ,roup C + E ,onorl
plu- opidurl no-iho-i ,roup.
DISCUSSION
Preoperative image examinations play an important
role in surgical treatment of pheochromocytoma and
anesthetic management
In ihi- -orio- houi 9% ol phoochromocyiom- oxi-iod
-pordiclly or cooxi-iod wiih oihor ondocrino iumor-. Ior
iho-o piioni- who ro hi,hly -u-pociod ol
phoochromocyiom hui lck hiochomicl ovidonco
ppliciion ol im,o oxminiion- wiih hi,h -pociliciiy lor
phoochromocyiom -uch - HIBC -hould ho con-idorod io
conlirm iho di,no-i-.
4
Il phoochromocyiom- ro lound
io cooxi-i wiih HE^ prooporiivoly oxci-ion ol
phoochromocyiom -hould ho -chodulod lir-i in ordor io
void lluciuiion ol hlood pro--uro nd unoxpociod
crdic nd corohrl v-culr ovoni- duo io iho -ur,o ol
ciocholmino durin, iho oporiion do-i,niod lor romovl
noihor cooxi-ioni iumor. In iho moniimo ii -hould ho
noiod ihi ondocrino di-o-o- -uch - hyporclcomi -
con-oquonco ol hyporprihyroidi-m nd low hlood
,luco-o lovol- ro-uliin, lrom in-ulinom mi,hi cooxi-i wiih
phoochromocyiom. Il phoochromocyiom- ro pro-oni in
hoih dronl ,lnd- nd hiliorl dronlociomy i-
niicipiod -upplomonil corii-ono iroimoni -hould ho
in-iiiuiod i iho iimo ol prooporiivo modiciion nd lior
hiliorl dronlociomy. 1ho im ol ihi- mnouvor i- io
provoni po-ioporiivo cuio hypodronocoriici-m nd
rolrciory hypoion-ion.
Uur di l-o -how ihi moro ihn hll ol iho piioni- hd
iho pro-oniiion- ol ciocholmino crdic ioxiciiy which
i- in ccordnco wiih proviou- ropori-.
5 6
Ii i- -u,,o-iod
ihi iho -ovoriiy ol impirod crdiov-culr lunciion
-hould ho crolully ovluiod hy olocirocrdio,rphic nd
ochocrdio,rphic oxminiion-. Ior piioni- who-o
phoochromocyiom i- compliciod wiih crdiomyopihy ii
i- prudoni io di-coniinuo iho u-o ol lon, ciin,
niihyporion-ivo dru,- nd !-hlockor- in ordor io void
prolon,od hypoion-ion duo io iho ro-idul olloci- ol iho-o
dru,- lior iho romovl ol phoochromocyiom.
Changes of hemodynamics in different anesthetic
groups and related management
Con-idorin, iho lci ihi wiih -uch lon, poriod ol
clinicl di nlyzod ohviou- dilloronco- in
porioporiivo dmini-iriion ol dru,- -ur,icl ioch-
niquo- nd no-ihoiic mn,omoni my oxi-i in dilloroni
poriod- wo only cho-o comploio no-ihoiic chri- in
Poriod 3. 1ho ro-uli- indicio ihi opidurl hlock
-i,nilicnily roduco- -y-iomic v-culr ro-i-inco which
i- honolicil io miniin -ihlo hlood pro--uro holoro
romovl ol iho iumour nd conirihuio- -i,nilicnily io iho
-prin, olloci on iho u-o ol v-odilior-. Alior iho
romovl ol iho phoochromocyiom ihoro w- no
-i,nilicni dilloronco mon, iho ihroo ,roup- in iho
porconi,o ol ciocholmino dmini-iriion indiciin,
ihi opidurl no-iho-i nd opidurl plu- ,onorl
no-iho-i my hvo dvni,o- ovor ,onorl no-iho-i
lono. Howovor ii h- hoon roporiod ihi opidurl
no-iho-i my ro-uli in -ovoro hypoion-ion lior iho
romovl ol iho phoochromocyiom nd ihi opidurl
no-iho-i my lloci pulmonry lvoolr voniiliion in
-odiod piioni-.
7
1horoloro opidurl comhinod wiih
,onorl no-iho-i my ho hoiior choico lor ihi- kind ol
-ur,ory.
A- lor iho mn,omoni ol homodynmic- durin, -ur,ory
ii i- ,onorlly ollicciou- io dmini-ior niiropru--ido nd
or phoniolmino io conirol iho hyporion-ivo ro-pon-o-
durin, iho -ur,icl mnipuliion. In c-o ol hyporion-ion
wiih ichycrdi comhiniion ol o-molol nd n ulir
-hori !-hlockor i- holplul. Alior oxci-ion ol iho
phoochromocyiom -olociion ol ciocholmino nd
iiiriion ol do-,o -hould ho mdo h-od on iho iypo ol
ciocholmino -ocroiod hy iho iumor nd iho -ovoriiy ol
hypoion-ion.
In iho pro-oni di ii i- -hown ihi hoih S\B nd CI ro
roducod lior iho ro-ociion ol iho iumor. Howovor CI
-hould ho ihooroiiclly incro-od lior iho roduciion ol
S\B. 1ho prdoxicl phonomonon oh-orvod in iho
pro-oni -iudy my ho roliod io iho hrupi roduciion ol
ondo,onou- ciocholmino in iho hlood lior iho romovl
ol iho iumor. In ddiiion ii i- -hown ihi iho numhor ol
ciocholmino rocopior- di-irihuiod in iho crdiov-culr
-y-iom in piioni- wiih phoochromocyiom i- docro-od
duo io iho lon,-iorm ciion ol hi,h lovol ol ciocholmino
-ocroiod hy phoochromocyiom which i- rocopior down
ro,uliion.
6
1ho numhor ol ciocholmino rocopior-
could noi rocovor io iho lovol ol norml condiiion- wiihin
-hori poriod lior iumor ro-ociion.
5
All iho-o
pihophy-iolo,icl chn,o- my ho --ociiod wiih iho
-imulinoou- doclino ol S\B nd CI lior iumor
ro-ociion.
Necessity of monitoring blood glucose and adjusting
fluid to be infused during the perioperative period
In iho pro-oni -iudy ,luco-o iolornco io-i- woro
hnorml in houi 59% piioni- prooporiivoly nd only
0 3 5 1 C/inese edico/ ]oucno/ 2003 116 10 1527-1531
39% ol iom roiurnod io normal alior io -ur,ory. 1o
ypor,lycomia -iaiu- holoro io romoval ol io
poocromocyioma may ho rolaiod io a i, lovol ol
circulaiin, caiocolamino- iai aci on io !-rocopior- ol
io pancroaiic " coll- and -uppro-- in-ulin roloa-o.
1
1o incroa-od caiocolamino- al-o incroa-o ,lyco,onoly-i-
and lroo laiiy acid lovol- in io hlood and a- a
con-oquonco provido aliornaio onor,y -uh-iraio- and
docroa-od ,luco-o cloaranco lrom io hlood. Un io oior
and ypo,lycomia may occur wiiin minuio- alior
romoval ol io iumor a- !-inducod -uppro--ion ol in-ulin
roloa-o wano-.
8 9
1o -uppro--ion ol "-coll lunciion
di-appoar- and pla-ma in-ulin lovol- ri-o ro-uliin, in
po-ioporaiivo ypo,lycomia and ovon lo-- ol con-ciou-no--
and ro-piraiory arro-i in -oriou- ca-o-.
10
Ii -ould ho
noiod iai io cla--ic -ympiom- ol ypo,lycomia mi,i ho
ma-kod durin, ano-io-ia and in io po-ioporaiivo poriod
won paiioni- aro undor iroaimoni ol anal,o-ic- and
-odaiivo-. Con-oquonily moniiorin, hlood ,luco-o in io
porioporaiivo poriod and adju-iin, io iypo ol lluid
inlu-od accordin, io io moniiorod ro-uli- may ho
noco--ary lor -omo paiioni-.
Importnce of preopertive hypertension control by
dministrtion of vsodiltors nd restortion of
blood volume
1o ovorall lovol ol -ur,ical iroaimoni lor poo-
cromocyioma dopond- on muliiplo lacior- includin,
adoquaio prooporaiivo proparaiion -ur,ical iocniquo-
iniraoporaiivo ano-ioiic mana,omoni and po-ioporaiivo
-uppori lor viial or,an dy-lunciion. 1oroloro ovon
iou, wo -iudiod io clinical ouicomo hy di-iin,ui-in,
dilloroni poriod- wii prooporaiivo parmacolo,ical
proparaiion io markodly roducod morialiiy raio-
oh-orvod in Poriod- 2 and 3 may ju-i rolloci ovorall
improvomoni in io iroaimoni lor poocromocyioma
-inco all io-o lacior- aro hoin, improvod -imulianoou-ly
a- iimo ,oo- on. ^ovoriolo-- io prooporaiivo
admini-iraiion ol a !-hlockor io conirol yporion-ivo
-iaiu- ol poocromocyioma and ro-ioro ol hlood volumo
i- crucial io io ouicomo ol -ur,ical iroaimoni and -ould
noi ho ovorlookod.
11
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wii radiolaholod HIBC and -omaio-iaiin analo,uo-. Somin
^ucl Hod 1995 25 272-278.
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