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Diagnosis and management of pheochromocytoma in an academic hospital 3 years after formation of a pheochromocytoma interest group.

OBJECTIVE
To examine whether establishment of a pheochromocytoma interest group improves diagnosis and management of pheochromocytoma in an academic hospital.


METHODS
The medical records of patients who had preoperative or pathologic diagnosis of pheochromocytoma at a large academic hospital from July 2007 to July 2010 were retrieved and pertinent information was gathered. Quality measures for diagnosis and management of pheochromocytoma before and after establishment of a pheochromocytoma interest group, and by group and nongroup physicians, were compared.


RESULTS
Between 2007 and 2010, 16 patients were confirmed to harbor pheochromocytoma. The rates of over-diagnosis and underdiagnosis were similar before and after establishment of the pheochromocytoma interest group (23%-25% vs 17%, respectively); however, after interest group formation, pheochromocytoma was excluded in 9 patients for whom other physicians recommended adrenalectomy. Compared with nonmembers, members of the pheochromocytoma interest group more frequently performed pheochromocytoma testing before adrenal biopsy or adrenalectomy in patients with adrenal masses (71% vs 13%), including those with suspected malignancy (50% vs 7%). After interest group formation, many more patients were optimally prepared preoperatively and advised on follow-up plan and genetic testing.


CONCLUSIONS
Formation of a pheochromocytoma interest group significantly enhances the quality of diagnosis and management of pheochromocytoma. The key to the group's success is its incorporation of members' formal or informal opinions into the care of patients with suspected pheochromocytoma. This model may be applied to other rare endocrine diseases.