Postoperative Management of Bilateral Adrenalectomy for Pheochromocytoma

Immediate Postoperative Management

• Aggressive treatment of postoperative hypotension is essential, as the sudden decrease in catecholamine levels following tumor removal can cause significant blood pressure drops 1, 2
• Close monitoring of blood glucose levels is crucial as hypoglycemia commonly occurs after the reduction of catecholamine levels 1, 2

Adrenal Insufficiency Management

• High-dose hydrocortisone (150 mg/day) should be administered during the immediate postoperative period 2, 4
• Standard maintenance therapy includes oral hydrocortisone 15-25 mg/day in divided doses (typically 2/3 in morning, 1/3 in afternoon) 4
• Fludrocortisone (0.05-0.2 mg daily) is required for mineralocorticoid replacement, with dosing based on blood pressure and serum potassium levels 4

Special Considerations

• Patients must be educated about stress dosing protocols for illness, surgery, or other stressors 4
• During periods of stress, glucocorticoid doses should be doubled or tripled 4
• All patients should wear medical alert identification indicating adrenal insufficiency 3

Follow-up Protocol

• First postoperative visit should occur within 2-4 weeks 3
• Biochemical testing should be performed 2-8 weeks after surgery to confirm complete tumor removal 3
• Regular monitoring of chromogranin A and metanephrines is recommended every 3-4 months for the first 2-3 years 5

Potential Complications to Monitor

• Symptoms of adrenal crisis include severe hypotension, nausea, vomiting, abdominal pain, and altered mental status 4
• Requires immediate treatment with IV hydrocortisone 100 mg and fluid resuscitation 4