Evolving Concepts in the Pathophysiology, Diagnosis, and Treatment of Pheochromocytoma

THE very first known successful operation for removal of a pheochromocytoma was performed by Cesar Roux in February 1926 in Lausanne, Switzerland (1). C. H. Mayo performed the first successful removal of a pheochromocytoma in North America in October of the same year (2). Since these first successful operations, considerable progress has been made in the diagnosis and treatment of pheochromocytoma. The availability of sensitive and specific immunoassay procedures, the development of simplified diagnostic testing, and the introduction of sensitive imaging techniques have enhanced the clinician's ability to make the diagnosis with greater certainty. In addition, a better understanding of catecholamine action and the pathophysiology of pheochromocytoma and an appreciation of the wide range of clinical manifestations associated with it have led not only to earlier recognition of the disease but also to a more rational approach to its diagnosis and management. Nevertheless, there are still uncertainties regarding the pathophysiology of hypertension, about optimal screening methods, the sensitivity and specificity of the various diagnostic tests, the diagnostic process, and the approach to treatment.