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Endocrine surgery · UK

Phaeochromocytoma surgery, by a specialist adrenal surgeon.

A properly prepared, MDT-led pathway for catecholamine-secreting tumours. BAETS-registered surgeons, specialist endocrine anaesthesia, two to three weeks of alpha-blockade and lifetime follow-up with clinical genetics.

A stethoscope on a clinical desk

Indicative pricing

What a private phaeochromocytoma pathway costs in London.

Indicative ranges across UK units.

Stage Indicative range
Endocrine and MDT assessment with adrenal-protocol imaging £1,800–£3,200
Laparoscopic adrenalectomy for phaeochromocytoma £18,000–£32,000
Open adrenalectomy or extra-adrenal paraganglioma resection £22,000–£38,000
Bilateral cortical-sparing adrenalectomy £26,000–£42,000
Germline genetic panel (SDHx, VHL, RET, NF1, TMEM127, MAX, FH) £450–£1,200
MIBG, FDG-PET or 68Ga-DOTATATE functional imaging £1,200–£3,400

Prices vary by unit, by which surgeon and anaesthetist take the case, and by tumour size, side and whether cortical-sparing or open resection is required.

The journey

From biochemistry to lifetime follow-up, what happens, in order.

One team from first message to annual surveillance, including alpha-blockade, HDU and clinical genetics.

  1. 03

    Before

    Alpha-blockade for two to three weeks

    Phenoxybenzamine is titrated upward, with a high-salt diet and volume expansion. Beta-blockade is added only once alpha-blockade is established.

  2. 04

    Admission and surgery

    Admission the day before surgery

    Overnight IV fluids at around one litre per hour. Potassium and magnesium are corrected. Arterial and central venous lines placed in theatre.

  3. 05

    Admission and surgery

    Laparoscopic or open adrenalectomy

    A specialist endocrine anaesthetist manages intraoperative catecholamine surges with phenylephrine, sodium nitroprusside and short-acting agents.

  4. 06

    Admission and surgery

    HDU for 24 to 48 hours

    Close monitoring for rebound hypotension once the tumour is out. Vasopressors are weaned as adrenoreceptors reset.

  5. 07

    After

    Histology, genetics and lifetime follow-up

    Histology at 7 to 14 days. Clinical genetics if not already arranged. Annual metanephrines and blood pressure for life given recurrence risk.

When to screen

Presentations that should be worked up.

The patterns that trigger a full biochemical and imaging work-up rather than another blood-pressure agent.

  • Classic triad with hypertension

    Episodic headaches, palpitations and sweating with paroxysmal or sustained hypertension is the textbook presentation.

  • Pallor, anxiety and weight loss

    Pale skin during spells, unexplained anxiety, weight loss and glucose intolerance often accompany a secreting tumour.

  • Orthostatic hypotension paradox

    A hypertensive patient who drops sharply on standing is a classic phaeo clue caused by volume contraction.

  • Incidentaloma over 4cm or lipid-poor

    An adrenal lesion picked up on scanning with a non-adenoma density needs biochemical screening before any biopsy.

  • Family history or known germline mutation

    SDHx, VHL, RET, NF1, TMEM127, MAX or FH carriers need screening even when asymptomatic.

  • Extra-adrenal or head-and-neck paraganglioma

    Tumours arising from paraganglia in the neck, chest or abdomen need dedicated imaging and often FDG-PET.

  • Refractory or crisis hypertension

    Blood pressure that will not settle on three or more agents, or a hypertensive crisis under anaesthesia, warrants screening.

  • Red flag: suspected metastatic disease

    Bone pain, weight loss or lymphadenopathy with raised metanephrines needs 68Ga-DOTATATE PET-CT and specialist oncology input.

Diagnosis and localisation

Biochemistry, imaging and germline testing.

A structured work-up that confirms secretion, locates the tumour and identifies the underlying genetic driver.

  • Plasma-free metanephrines

    Highest sensitivity and specificity of the biochemical tests. Fractionated metanephrine, normetanephrine and methoxytyramine, drawn supine and rested.

  • 24-hour urinary metanephrines

    Fractionated urinary metanephrines with creatinine. An elevated result needs a confirmatory second collection before proceeding to imaging.

  • Clonidine suppression test

    Reserved for borderline biochemistry. Normal noradrenergic tone suppresses; autonomous tumour secretion does not.

  • CT and MRI adrenal protocol

    Adrenal-protocol CT with washout, or MRI with in and out of phase sequences. Extended to neck, chest and pelvis for extra-adrenal disease.

  • MIBG scintigraphy

    123I-metaiodobenzylguanidine has around 80 per cent sensitivity for phaeochromocytoma and helps confirm functional adrenal uptake.

  • 18F-FDG PET-CT

    More sensitive than MIBG for SDHB-mutated and extra-adrenal paragangliomas. The functional imaging of choice in this group.

  • 68Ga-DOTATATE PET-CT

    The most sensitive scan for metastatic and head-and-neck paraganglioma and guides eligibility for peptide-receptor radionuclide therapy.

  • Germline genetic testing

    Mandatory in all cases. Around 30 to 40 per cent carry a germline mutation. Cascade screening for first-degree relatives is arranged through clinical genetics.

Safety and recovery

What to expect, honestly.

The preparation, the theatre, the HDU stay and the lifetime follow-up. Handled properly, this is a well-established operation with excellent outcomes.

  • Alpha-blockade must come first

    Phenoxybenzamine 10 to 40 mg three times daily is titrated over two to three weeks with a high-salt diet. Beta-blockade added only after this is established.

  • Never beta-blockade alone

    Unopposed alpha stimulation triggers a hypertensive crisis. Propranolol or atenolol is added three to five days after alpha-blockade if tachycardia persists.

  • Preoperative targets

    Supine blood pressure under 120 over 80, an acceptable postural drop, and supine heart rate under 80. A calcium channel blocker may be added.

  • Intraoperative catecholamine surges

    Tumour manipulation releases catecholamines. Sodium nitroprusside, phenylephrine and short-acting beta-blockers are drawn up before incision.

  • Rebound hypotension after resection

    Once the tumour is out, catecholamine drive stops while adrenoreceptors remain down-regulated. HDU observation for 24 to 48 hours is standard.

  • Bilateral disease and Addison’s risk

    Cortical-sparing adrenalectomy is preferred when both glands are involved to avoid lifelong steroid replacement.

  • Malignant phaeochromocytoma

    Around 10 to 15 per cent metastasise. Treatment involves 131I-MIBG, CVD chemotherapy, sunitinib or 177Lu-DOTATATE PRRT with five-year survival of 50 to 90 per cent.

  • Lifetime surveillance

    Annual metanephrines, blood pressure and calcium. Germline carriers need mutation-specific screening for life given recurrence risk.

  • Red flags after discharge

    Severe headache, chest pain, palpitations, sweating or a hypertensive spike above 180 over 110 needs the on-call team or A&E the same day.

Reading your operation note

Your surgical report in four parts. Read the last one first.

Whichever approach was used, the operation note and histology keep to the same shape.

  1. 01 Header

    Site, size and secretory profile

    Adrenal or extra-adrenal, tumour size in millimetres, the pattern of metanephrine elevation and any germline mutation identified.

  2. 02 Technique

    Surgical approach and cortical-sparing status

    Laparoscopic transperitoneal, posterior retroperitoneoscopic or open. Whether cortical-sparing was achieved on either side.

  3. 03 Findings

    Intraoperative course and margins

    Number and severity of intraoperative hypertensive spikes, blood loss, margin status and the PASS or GAPP score for malignancy risk.

  4. 04 Impression

    Follow-up and genetics plan

    Read this first: biochemistry at 4 to 6 weeks, imaging schedule, clinical genetics referral and lifetime annual review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for phaeochromocytoma surgery is usually funded when medically indicated.

Frequently asked

Everything we get asked about phaeochromocytoma surgery.

  • What is a phaeochromocytoma and how does it differ from a paraganglioma?

    A phaeochromocytoma is a catecholamine-secreting tumour of the adrenal medullary chromaffin cells. A paraganglioma arises from extra-adrenal paraganglia in the neck, chest or abdomen. Around 30 to 40 per cent of both are linked to a germline mutation such as SDHx, VHL, RET, NF1, TMEM127, MAX or FH.

  • Why is preoperative alpha-blockade so important?

    Uncontrolled catecholamine release during surgery can cause severe hypertensive crisis, arrhythmia and myocardial infarction. Two to three weeks of phenoxybenzamine, combined with a high-salt diet and volume expansion, blunts these surges and prevents post-operative hypotension once the tumour is removed.

  • How much does private phaeochromocytoma surgery cost in the UK?

    Laparoscopic adrenalectomy at a BAETS-registered specialist high-volume centre with cardiac anaesthesia, endocrine and genetics MDT is around £18,000 to £32,000. Open surgery or paraganglioma resection is around £22,000 to £38,000.

  • Which imaging tests do I actually need?

    Adrenal-protocol CT or MRI localises the tumour. MIBG scintigraphy is added for confirmation of functional uptake. SDHB and extra-adrenal tumours are better characterised on 18F-FDG PET-CT, and 68Ga-DOTATATE PET-CT is used for suspected metastatic disease.

  • Do I need genetic testing even if no one else in my family has this?

    Yes. Around a third of apparently sporadic cases carry a germline mutation. Testing changes surveillance for you and triggers cascade screening for first-degree relatives. Referral to clinical genetics is arranged before or shortly after surgery.

  • What follow-up will I need after surgery?

    Biochemistry at four to six weeks, then annual plasma or urinary metanephrines and blood pressure for life given recurrence risk. Germline mutation carriers have additional mutation-specific screening, including calcium for RET, retinal and CNS imaging for VHL, and abdominal and neck imaging for SDHx.

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