Behind The Knife: The Surgery Podcast

Clinical Challenges in Surgical Oncology: Pheochromocytomas

Oct 2, 2025
Dive into the fascinating world of pheochromocytomas and their clinical challenges. The hosts discuss key diagnostic steps, including the significance of plasma-free metanephrines over urine testing. Explore the intricate genetic factors involved and the necessity for thorough genetic testing. Surgical strategies are covered, detailing both minimally invasive approaches and the classic open techniques, along with a focus on managing intraoperative hemodynamic risks. The conversation wraps up with insights on postoperative care and long-term surveillance.
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ADVICE

Start With Plasma Metanephrines

  • Check plasma free fractionated metanephrines first for suspected pheochromocytoma because it is simple and rapid.
  • Use a 24-hour urine only if plasma is equivocal or clinical suspicion remains high.
INSIGHT

High Rate Of Germline Mutations

  • Over 40% of pheochromocytomas are associated with germline mutations, so genetic testing is common.
  • This shifts thinking from rare familial cases to routine genetic evaluation for many patients.
ADVICE

Get Genetic Testing Before Surgery

  • Obtain genetic testing before surgery because results can change operative planning, especially in younger patients.
  • Consider cortical-sparing adrenalectomy when a hereditary syndrome predicts future bilateral disease.
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