The primary treatment for a pheochromocytoma is surgery to remove the tumor. Before you undergo surgery, your doctor will prescribe specific blood pressure medications that block the actions of the high-adrenaline hormones to lower the risk of developing dangerously high blood pressure during surgery.
You will likely take two drugs for seven to 10 days that help lower blood pressure before surgery. These drugs will either replace or be added to other blood pressure drugs you take.
- Alpha blockers keep smaller arteries and veins open and relaxed, improving blood flow and decreasing blood pressure. Alpha blockers include phenoxybenzamine (Dibenzyline), doxazosin (Cardura), and prazosin (Minipress). Side effects might include irregular heartbeat, dizziness, fatigue, vision problems, sexual dysfunction in men and swelling in your limbs.
Beta blockers cause your heart to beat more slowly and with less force. They also help keep blood vessels open and relaxed. In preparing for surgery a beta blocker is added several days after starting the alpha blocker.
Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL). Possible side effects include fatigue, upset stomach, headache, dizziness, constipation, diarrhea, irregular heartbeat, difficulty breathing and swelling in the limbs.
- High-salt diet Alpha and beta blockers widen (dilate) the blood vessels, causing the amount of fluid within the blood vessels to be low. This can cause dangerous drops in blood pressure with standing. A high-salt diet will draw more fluid inside the blood vessels, preventing the development of low blood pressure during and after surgery.
In most cases, the entire adrenal gland with a pheochromocytoma is removed with laparoscopic, or minimally invasive, surgery. Your surgeon will make a few small openings through which he or she inserts wandlike devices equipped with video cameras and small tools.
The remaining healthy adrenal gland carries out the functions normally performed by two, and blood pressure usually returns to normal.
In some unusual situations, such as when the other adrenal gland has been removed, surgery might remove only the tumor, sparing some healthy tissue.
If a tumor is cancerous (malignant), the effectiveness of surgery might rely on removing the tumor and all cancerous tissue. However, even if all of the cancerous tissue isn't removed, surgery might limit hormone production and provide some control of blood pressure.
As cancer is rare among cases of pheochromocytoma, the research about the best treatments is relatively limited. Treatments for malignant tumors and metastasized cancer related to a pheochromocytoma might include:
- Radionuclide treatment. This radiation therapy combines MIBG, a compound that attaches to adrenal tumors, with a type of radioactive iodine. The treatment goal is to deliver radiation therapy to a specific site and kill cancerous cells.
- Chemotherapy. Chemotherapy is the use of powerful drugs that kill fast-growing cancer cells.
- Targeted cancer therapies. These medications inhibit the function of naturally occurring molecules that promote the growth and spread of cancerous cells.