Phaeochromcytoma Crisis
Phaeochromcytoma crisis is a condition with significant mortality. Maintaining a high degree of clinical suspicion will facilitate prompt diagnosis of PCC, and utilizing the best available supportive treatments in an expert centre will give the patient the best chance of survival. Intravascular resuscitation and alpha-blockade are the specific treatments with the best evidence base. However, calcium channel blockers and magnesium sulphate are also effective particularly when combination therapy is required to achieve medical stabilization. Mechanical circulatory supportive therapy, including IABP, ECMO and cardiopulmonary bypass, is the treatment of choice in patients with type B crisis. There may be a role for emergency surgery in patients persistently unresponsive to such treatments, but this is controversial.
There is a need for collaboration between an endocrinologist and intensivist together with an endocrine surgeon and experienced anaesthetist in almost all cases of PCC. A national audit of current practice and subsequent formal management guidelines should be considered.
Conclusion
Phaeochromcytoma crisis is a condition with significant mortality. Maintaining a high degree of clinical suspicion will facilitate prompt diagnosis of PCC, and utilizing the best available supportive treatments in an expert centre will give the patient the best chance of survival. Intravascular resuscitation and alpha-blockade are the specific treatments with the best evidence base. However, calcium channel blockers and magnesium sulphate are also effective particularly when combination therapy is required to achieve medical stabilization. Mechanical circulatory supportive therapy, including IABP, ECMO and cardiopulmonary bypass, is the treatment of choice in patients with type B crisis. There may be a role for emergency surgery in patients persistently unresponsive to such treatments, but this is controversial.
There is a need for collaboration between an endocrinologist and intensivist together with an endocrine surgeon and experienced anaesthetist in almost all cases of PCC. A national audit of current practice and subsequent formal management guidelines should be considered.
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