Renal artery alterations associated with pheochromocytoma

Renal arterial disease is an important potential complication of pheochromocytoma. A classification is presented of the variety of mechanisms by which such renal artery alterations may arise in association with pheochromocytoma. In the pre-operative period the renal artery may be directly compressed by tumor mass or secondarily involved by neurofibromatosis, fibromuscular dysplasia or catecholamine-induced spasm. In the post-operative period renal arterial compromise may result from vascular trauma during surgery, recurrent tumor or periarterial adhesions. Angiography in patients with pheochromocytoma is clearly indicated for localization of the tumor(s) and evaluation of the renal artery for associated disease. The tumor is usually identified by a network of neovascularity and a tumor stain. Smooth segmental stenosis, beading, encasement, or persistent spasm of the renal artery indicates complicating renal arterial compromise. Renovascular hypertension should be recognized as a potential complication of the renal artery stenoses associated with pheochromocytoma, and attempts should be made to assess the functional significance of this contribution to hypertension pre-operatively in order to plan definitive surgery.