The best treatment for most pheochromocytomas is surgery to remove the tumor. If you can't have the surgery or to lower your blood pressure before surgery, your doctor likely will prescribe drugs.
Medications used to treat high blood pressure associated with pheochromocytomas include:
- Alpha blockers. Alpha blockers, also called alpha-adrenergic blocking agents or alpha-adrenergic antagonists, relax certain muscles that help small blood vessels remain open. They work by keeping the hormone noradrenaline (norepinephrine) from stimulating the muscles in the walls of smaller arteries and veins. This stimulation makes the vessel walls constrict. Blocking that effect causes the vessels to remain open and relaxed. This improves blood flow and lowers blood pressure. Examples of alpha blockers include phenoxybenzamine (Dibenzyline), doxazosin (Cardura), prazosin (Minipress) and terazosin (Hytrin). Side effects may include headache, pounding heartbeat, nausea and weight gain.
- Beta blockers. Beta blockers, also known as beta-adrenergic blocking agents, make your heart beat more slowly and with less force. They work by blocking the effects of the hormone norepinephrine. This action slows down the nerve impulses that travel through your heart. That means your heart doesn't pump as hard because it needs less oxygen and blood. Beta blockers also slow down the release of the enzyme renin from your kidneys, helping keep blood vessels dilated. Examples of beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol XL) and propranolol (Inderal LA, Innopran XL). Side effects may include fatigue, headache, upset stomach and dizziness.
- Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels in your arteries. They lower your blood pressure by preventing calcium from entering the cells of your heart and blood vessel walls. Examples of calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem LA, Tiazac, others) and nicardipine (Cardene SR). Side effects may include constipation, headache, rapid heartbeat (tachycardia) and drowsiness.
- Metyrosine (Demser). This drug lowers blood pressure by inhibiting the production of catecholamines. It may be used when other drugs haven't worked or with other drugs. Side effects may include drowsiness, depression, anxiety and diarrhea.
For a pheochromocytoma, alpha blockers are used first to return your blood pressure back to within normal limits. Once your blood pressure is lowered, beta blockers can help control a rapid or irregular heartbeat. Any of these drugs may be used in preparation for surgery.
Surgery to remove an adrenal gland
The most common treatment for a pheochromocytoma is surgical removal of the entire affected adrenal gland. In most cases, signs and symptoms then disappear. Blood pressure usually returns to normal soon after surgery. Before surgery, your doctor will prescribe medications to block the effects of the adrenal hormones and control blood pressure. If both adrenal glands are affected by pheochromocytoma and are surgically removed, you'll need to take medication to replace the other hormones once produced by these glands.
Laparoscopic surgery an option
Depending on the size and location of the tumor, laparoscopic surgery may be performed. Laparoscopic surgery involves inserting instruments through several small incisions. This procedure may result in quicker recovery compared with conventional surgery, which requires a larger incision. Although it's becoming more widely used for pheochromocytoma, laparoscopic surgery isn't for everyone. Talk to your doctor about this less invasive technique to see if it's an option for you.
Surgery may not be possible
Sometimes surgery isn't an option because of the way the tumor is growing or because the tumor has spread (metastasized) to other parts of your body. If a pheochromocytoma is cancerous (malignant), treatment may go beyond medication and surgery to include radiation, chemotherapy or destroying the function (ablation) of arteries that supply blood to the tumor.
Apr. 05, 2011
- Young WF, et al. Clinical presentation and diagnosis of pheochromocytoma. http://www.uptodate.com/home/index.html. Accessed Dec. 13, 2010.
- Young WF, et al. Treatment of pheochromocytoma in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 13, 2010.
- Blake MA, et al. Adrenal imaging. American Journal of Roentgenology. 2010;194:1450.
- Mazzaglia PJ, et al. Laparoscopic adrenalectomy: Balancing the operative indications with the technical advances. Journal of Surgical Oncology. 2010;101:739.
- Patient education: Pheochromocytoma. National Institutes of Health. www.cc.nih.gov/ccc/patient_education/pepubs/pheo.pdf. Accessed Dec. 19, 2010.
- Pheochromocytoma. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec12/ch153/ch153h.html. Accessed Dec. 19, 2010.