Pheochromocytoma is a neuroendocrine tumor that secretes neuropeptides that result in elevated blood pressures and tachycardia. Often, refractory to 56 different blood pressure medications with excellent compliance, and negative sleep study with still persistent elevated blood pressures, so signs and symptoms are tachycardia, diaphoresis, and poorly controlled hypertension. To make the diagnosis you need two things: the first is serum and urine metanephrine will be extremely elevated (I’m talking in the thousands). Often we find pheos with imaging, think of a CT chest/abdomen/pelvis. Pheos are often present in the adrenal glands, but may arrive in the adrenals from metastasis. So the second criteria to diagnosis a pheochromocytoma includes tissue biopsy. This is often performed by general surgery or surg onc. Treatment includes close alpha and beta blockade prior to surgery, with the backbone of treatment as adrenalectomy/debulking. Pheos should be monitored in the ICU perioperatively to monitor for cardiogenic shock requiring ecmo.

#education #surgery #generalsurgery #medicine #highyield #gensurg #shelf #exam #examination #usmle #residency #review #learn #educate #teach #coach #adrenal #hypertension