What Clinical parameters to be monitored in the postoperative period of pheochromocytoma surgery?
• Persistent hypertension reflects:
• Fluid overload
• Return of autonomic reflexes
• Inadvertent ligation of renal artery
• Presence of residual tumor
• Persistent hypotension often reflects:
• Blood loss
• Altered vascular compliance
• Residual effect of preoperative α-blockade
• Downregulation of adrenoceptors (left over from chronic stimulation preoperatively)
• Hypoglycemia
• Removal of inhibitory effect of catecholamines on pancreatic beta cells
• Increased sensitivity of the beta cells to glucose level after tumor removal
• Cessation of enflurane anesthesia, which leads to reflexive increase in insulin
• Assess risk for familial syndromes and possible genetic testing
• Serum calcium, calcitonin, and intact parathyroid hormone
• Ophthalmologist examination for retinal angiomas; consider head CT for cerebellar hemangioblastomas
• Consider mutation analysis for the ret proto-oncogene for familial and other high-risk cases
• Assess risk for residual tumor
• A screening test that was positive preoperatively should be repeated 1 to 2 weeks after surgery and annually thereafter
