Value of Systemic Hormonal Unloading in Pheochromocytoma


Systemic unloading of adrenaline improves blood pressure (BP) but the effect on the quality of life is not emphasized. This report aims to examine the outcome of systemic hormonal unloading through unilateral adrenalectomy in three pheochromocytoma cases.

Case 1: 20-year-old male presented with anxiety, severe headaches and BP 150/100 mmHg, taking terazosin and amlodipine. Stimulated bilateral adrenal venous sampling with glucagon stimulation (SBAVS-GS) showed predominant right adrenal secretion. Post right unilateral adrenalectomy, he is asymptomatic with usual BP 110-120/60-70 mmHg without medication.

Case 2: 51-year-old male presented with panic attacks, sweating, palpitations, headaches and BP 220/110 mmHg, given terazosin and amlodipine. SBAVS-GS showed predominant right adrenal secretion. Post right unilateral adrenalectomy, he reported reduction of symptoms. His usual BP is 100-130/60-80 mmHg on low dose amlodipine.

Case 3: 27-year-old female presented with severe headache, dizziness, spontaneous epistaxis, palpitations and BP 210/140 mmHg, taking bisoprolol, terazosin and clonidine. SBAVS-GS showed predominant right adrenal secretion. Post right unilateral adrenalectomy, she had less headache and dizziness. Her BP is 110-140/70-90 mmHg on a single anti-hypertensive drug.

Conclusion: Systemic hormonal unloading via unilateral adrenalectomy of the dominantly hormonal secreting adrenal gland is a good treatment option for pheochromocytoma; consequently, improving quality of life significantly.

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