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Endocrine Surgery

Adrenal Tumors

Catecholamine producing tumors or Pheochromocytomas and paragangliomas

  • What is a pheochromocytomas?
    • A pheochromocytoma is an adrenaline-producing tumor found in center, or medulla, of the adrenal gland. The adrenaline hormones, epinephrine and norepinephrine, are your “flight or fight” hormones.

  • What is a paraganglioma?
    • A paraganglioma is a rare adrenaline-producing tumor found outside the adrenal gland that grows in the peripheral nervous system. They can either be non-functioning or generally produce only norepinephrine (with one exception). Common places are in the abdomen along the aorta and in the neck along the carotid artery.

  • What are the symptoms?
    • Common symptoms may include: high blood pressure, either continuous or episodic, palpitations, headaches, and sweating.
    • There are many other less common, non-specific symptoms.
    • You may have a tumor that produces small amounts of adrenaline so as not to cause any obvious, overt symptoms.
    • A constellation of symptoms may occur after a procedure or eating certain foods. If this happens, you should be evaluated for a pheochromocytoma.

  • How is it diagnosed?
    • Diagnosis is made through a series of blood tests, sometimes urine tests, and imaging. There is no role for needle biopsy and is contraindicated.
  • Are there any risk factors?
    • The only known risk factors are certain genetic syndromes and mutations.
    • The most common of these are: Multiple Endocrine Neoplasia Syndrome types 2A and 2B, von Hippel-Lindau Syndrome, Neurofibromatosis 1, Familial Paraganglioma Syndromes (SDH mutations). 

  • What is the treatment?
    • Treatment is surgery. A laparoscopic, minimally invasive surgery is used for all tumors confined to the adrenal gland.
    • Very large adrenal tumors and those that have extended to adjacent structures, as well as the majority of abdominal paragangliomas require an open surgical procedure.

  • Will I be off all my high blood pressure medication after the surgery?
    • Most likely, though not necessarily right away. Sometimes your body needs time to reregulate itself and your medication may have to be weaned off more slowly. 

  • Do I need regular follow-up visits?
    • Yes. Pheochromocytomas can come back either in the same area, the other adrenal gland, or other areas in the body.
    • You will have lifelong follow-up with your endocrinologist and possibly your surgeon and yearly blood tests to monitor for recurrence.

  • Do I need to see a genetic counselor?
    • Current recommendations for referral to a genetic counselor include young age at diagnosis (< 30 or 40), bilateral pheochromocytomas, all paragangliomas, family history of one of these tumors or genetic syndromes.
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Upper G.I. and General Surgery

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