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[Diagnosis and preoperative management of patients with pheochromocytoma].

Hitoshi Takeshima, Hiroshi Tomomasa, Shinichi Yoshii Tohru Shimazui and Fukuji Kondoh Tsukuba University Hospital (Director: Prof. I. Ito) Hiromichi Ishikawa and Kenkichi Koiso Department of Urology (Director: Prof. K. Koiso), Institute of Clinical Medicine, University of Tsukuba Clinical analyses were made on diagnosis and preoperative management of 7 patients with pheochromocytoma (male 2, female 5) in the last 6 years. Chief complaints were palpitation in 3 patients, hypertension, edema in the extremities and headache each in 1 patient. One patient was found to have pheochromocytoma during close examination of another disease. ECG showed abnormal findings in 6 of the 7 patients. Ophthalmoscopic examination showed abnormal findings in all patients. Diabetes mellitus was found in 2 patients. Endocrinological studies revealed abnormal levels of noradrenaline and VMA in urine in all patients. Computed tomography, ultrasonography and 1311-MIBG (meta-iodobenzyl guanidine) scintigraphy were reliable procedures for the accurate determination of localization of pheochromocytomas. Reductions of both circulating blood volume and circulating plasma volume were found in 3 patients. Four of the 7 patients were hypertensive before treatments. It was established that quinazoline derivatives, which replaced pheoxybenzamine as alpha-adrenergic recepter blocking agent, were quite useful. Preoperative evaluation of haemodynamics with Swan-Ganz catheter monitoring revealed no serious abnormal findings in 5 patients. This procedure also seemed to be indispensable for intraand postoperative management of patients with pheochromocytoma.