Recognition and management of phaeochromocytoma

Phaeochromocytomas are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a workup for multiple endocrine neoplasia or during unrelated surgery. Better understanding of catecholamine physiology and advances in preoperative preparation has significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection is associated with reduced hospital stay and earlier mobilisation. Phaeochromocytomas are of particular interest to anaesthetists as it presents a unique haemodynamic challenge both before and after adrenal resection. In this article we describe the physiology of these tumours, their diagnosis and perioperative management.