Thep Himathongkam, MD; Stephen R. Newmark, MD; Martin Greenfield, MD; Robert G. Dluhy, MD
JAMA. 1974;230(12):1692-1693. doi:10.1001/jama.1974.03240120060026.
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PHEOCHROMOCYTOMA is a rare catecholamine-secreting tumor usually of the adrenal medulla, but occasionally it arises in other neural crest-derived tissues. The clinical presentation is episodic or persistent hypertension associated with flushing, sweating, and tachycardia or cardiac arrhythmias. An acute hypertensive episode may be precipitated by exercise, ingestion of tyramine-containing compounds, external pressure on the tumor, anesthesia, monoamine oxidase inhibitor drugs, or surgery. The diagnosis can be confirmed by elevated urine levels of vanillylmandelic acid, metanephrines, and catecholamines.1,2

Therapy  The only definitive treatment of pheochromocytoma is surgical removal of the tumor. Therefore, the following discussion on therapy will emphasize the treatment of an acute hypertensive episode along with the medical management of the patient prior to and during surgery.

Reduction of Blood Pressure During Acute Hypertensive Episode.—  When a hypertensive patient is suspected of having a pheochromocytoma, the patient should be confined to bed, with the head elevated at a


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