Management of Pheochromocytoma

• Alpha-Blocker:

• Phenoxybenzamine 10 mg BID-40 TID po

• Phentolamine 5-15 mg IV (acute paroxysm)

• Beta-Blocker: (only after alpha-blocker)

• Propanalol 10-60 mg po QID

• Calcium Channel Blocker:

• Nicardipine 30-60 mg po BID

• Catecholamine Synthesis Inhibitor: (Inhibits tyrosine hydroxylase rate limiting step)

• Metyosine 250-750 mg po QID

• Side Effects: Crystalluria, Parkinsonism, Depression. Salivation, Ejacualtion dysfunction, Galactorrhea

• Volume Expansion: Sodium > 5000 mg day/ IV NS

• Malignant Pheochromocytoma:

• Cyclophsphamide, Vincristine, Dacarbazine

• Complete Clinical Response 57%; Duration 21 months Averbuch et al Ann Int Med 1988; 109:267