SUCCESSFUL surgical removal of a phaeochromocytoma is still a relatively rare accomplishment. A review of the available world's literature at this date has yielded reports of 176 such tumors, but only 47 of these were proven to be endocrinologically active by cessation of symptoms following surgical removal. The inherent difficulties in dealing with patients suffering from phaeochromocytomata are many. They may be divided into three categories and briefly listed as follows: Diagnosis: Although the classical syndrome produced by such tumors is striking and clear cut (18), any individual case may lack one or more of the features which would ordinarily direct attention toward the correct diagnosis. Especially difficult are those patients in whom a permanent sustained hypertension is manifested and in whom the clinical diagnosis of essential hypertension may be made.1 Localization: When reasonable certainty of the presence of a phaeochromocytoma exists, localization of the offending tumor is often fraught with grave difficulties. Omitting tumors of the carotid body, which have not been known to produce hypertensive attacks, 89 per cent of all adult chromaffin tumors reported have been found in or adjacent to one or the other of the adrenal glands. Nevertheless, only when the tumor is of considerable size may it be positively identified in these areas by means other than surgical exploration.2 Characteristic symptoms have occurred in patients subsequently proven to have chromaffin tumors of Zuckerkandl's body, the retroperitoneal ganglia, the semilunar ganglia (36) and even the thoracic sympathetic ganglia (30).
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Calkins et al. (1947) studied this question.