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Figure 9-2. Cut surface of the right adrenal pheochromocytoma specimen showing areas of necrosis and cysts. Courtesy of Quan-Yang Duh, MD.

normetanephrine excretion in 1958.1 Initially, fluo-rometric assays were used but suffered from non-specificity. More recently, high-pressure liquid chro-matography (HPLC) with electrochemical detection has been used to determine urinary concentrations of fractionated catecholamines and metanephrines (see below).

Surgical techniques progressed from open laparo-tomy to unilateral posterior or flank approaches, with the aid of preoperative localization with computed tomography (CT) or magnetic resonance imaging (MRI). More recently, laparoscopic removal of most pheochromocytomas has become possible, further reducing perioperative morbidity (see below).

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