- Pheochromocytoma is an extremely rare cause of hypertension, but diagnosing it can lead to curative surgery.
- Suspect the diagnosis in unusual cases of hypertension such as paroxysmal episodes, severe orthostatic hypotension, those with the Classic Triad of headache + diaphoresis + palpitations, cases of very resistant HTN, paradoxical hypertensive response to Beta-Blockers, unexplained shock from trauma or surgery, and HTN in the young.
- Make sure to get Plasma Free Metanephrines during an acute episode if you have clinical suspicion.
- Medical management in acute presentation should start with Phentolamine first, anticipate the need for fluid resuscitation from vasodilation, then addition of Esmolol or Labetalol only after alpha blockade. Can go to Nitroprusside if resistant. Lidocaine, Amiodarone, Metoprolol or Atenolol for continued tachydysrhythmias.
- Emergent surgery is associated with worse outcomes and should only be considered a last resort after all other medical management has failed.
- Patients need to be prepped for surgery with at least 3 weeks of PO alpha and beta blocker therapy.