Anesthesiology pp 679-687 | Cite as

Anesthesia for Pheochromocytoma and Glomus Jugulare

  • Courtney C. Elder
  • Kavitha A. MathewEmail author


Pheochromocytomas (PCCs) are hormonally active adrenal tumors that secrete supraphysiologic levels of catecholamines resulting in chronic sympathetic stimulation. Patients most commonly present with signs and symptoms of adrenergic excess such as paroxysmal hypertension, tachycardia and headache. Alternatively, these tumors may be discovered as incidental masses on abdominal imaging. Surgical resection is currently the only definitive treatment for PCC; it does however, carry the risk of provoking severe intraoperative hemodynamic instability. Perioperative anesthetic considerations for pheochromocytoma resection include adequacy of preoperative adrenergic blockade and volume resuscitation, invasive hemodynamic monitoring, and the anticipation, mitigation and treatment of intraoperative sympathetic stimulation. Current practice guidelines for patient optimization and perioperative management are based largely on retrospective cohort data, as little prospective research is available in the existing literature.


Pheochromocytoma Paraganglioma Adrenalectomy Alpha blockade Phenoxybenzamine Metyrosine Hypertensive crisis Adrenal excess Catecholamines 


  1. 1.
    Challis BG, Casey RT, Simpson HL, Gurnell M. Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma? Clin Endocrinol. 2017;86:163–7. Scholar
  2. 2.
    Pacak K, Timmers HJ, Eisenhofer G. Pheochromocytoma. In: Jameson JL, De Groot LJ, de Kretser DM, Guidice LC, Grossman AB, Melmed S, et al., editors. Endocrinology: adult and pediatric. 7th ed. Philadelphia: Elsevier; 2016. p. 1902–30.CrossRefGoogle Scholar
  3. 3.
    Fleisher LA, Mythen M. Anesthetic implications of concurrent diseases. In: Miller’s anesthesia. 8th ed. Philadelphia: Elsevier; 2015. p. 1156–225.Google Scholar
  4. 4.
    Randle RW, Balentine CJ, Pitt SC, Schneider DF, Sippel RS. Selective versus nonselective α-blockade prior to laparoscopic adrenalectomy for pheochromocytoma. Ann Surg Oncol. 2017;24:244–50. Scholar
  5. 5.
    Petri BJ, van Eijck CH, de Herder WW, Wagner A, de Krijer RR. Phaeochromocytomas and sympathetic paragangliomas. Br J Surg. 2009;96:1381–92. Scholar
  6. 6.
    Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:1915–42. Scholar
  7. 7.
    Weingarten TN, Weich TL, Moore TL, Walters GF, Whipple JL, Cavalcante A, et al. Preoperative levels of catecholamines and metanephrines and intraoperative hemodynamics of patients undergoing pheochromocytoma and paraganglioma resection. Urology. 2017;100:131–8. Scholar
  8. 8.
    Brunaud L, Nguyen-Thi PL, Miralle E, Rafaelli M, Vriens M, Theveniaud PE, et al. Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients. Surg Endosc. 2016;30:1051–9. Scholar
  9. 9.
    Lentschener C, Gaujoux S, Tesniere A, Dousset B. Point of controversy: perioperative care of patients undergoing pheochromocytoma removal- time for a reappraisal? Eur J Endocrinol. 2011;165:365–73. Scholar
  10. 10.
    Hariskov S, Schumann R. Intraoperative management of patients with incidental catecholamine producing tumors: a literature review and analysis. J Anaesthesiol Clin Pharamcol. 2013;29:41–6. Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Emory University School of MedicineAtlantaUSA

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