Monitoring

In the immediate postoperative period catecholamine levels can still remain high. The patient requires assessment of plasma metanephrines and normetanephrines to check for normalization about 2-6 weeks postoperatively.[57] If these plasma studies are positive, this necessitates an imaging test at 3 months to evaluate for persistent tumor.[57] At present it is recommended that patients should have yearly follow-ups for at least 10 years to check for local or metastatic recurrences or new tumors.[57] As patients with a history of pheochromocytoma have an overall increased risk of death, some experts advocate lifelong follow-up and screening for recurrent tumors in sporadic cases and for associated tumors in hereditary cases.[57][100]

Based on more recent data, the risk of recurrent disease after complete resection of a pheochromocytoma may be as low as 5 events for 100 patients followed up for 5 years, and, therefore, lifelong follow-up may not be necessary for some sporadic cases. Yearly monitoring should be tailored to the patient's risk for recurrence.[101]

Follow-up consists of a minimum of once yearly BP measurement, as well as measurement of plasma metanephrine and normetanephrine. Chromogranin A is a nonspecific marker of the presence of a neuroendocrine tumor and can be used as a screening tool to detect recurrences.[56] Imaging tests should be performed every 1 to 2 years in patients with biochemically inactive pheochromocytoma to screen for recurrence or new tumors.[57] In the future, follow-up may be tailored to the specific molecular characteristics of a tumor that may act as markers for recurrent disease. There are, however, currently known characteristics that may predict recurrence: namely, bilateral disease, disease occurring at a young age, larger tumors, and hereditary pheochromocytomas.

Up to 40% of pheochromocytomas are hereditary in adults; therefore, genetic testing is indicated for all patients with pheochromocytomas to identify potential hereditary tumor disorders that would necessitate more detailed evaluation and follow-up.[1][3][102][103] The particular tests indicated can be guided by the features of the tumor, the hormones produced, as well as comorbidities and family history.

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