Medical Management of Pheochromocytoma in a 95-Year-Old Woman: A Case Report of Long-Term Conservative Therapy

Introduction: Pheochromocytoma is a rare catecholamine-secreting tumor typically managed with surgical resection. However, in elderly patients with significant comorbidities, surgery may not be feasible due to high perioperative risk. We describe a 95-year-old woman with biochemically confirmed pheochromocytoma who declined surgery in her 80s and achieved sustained blood pressure control through long-term conservative medical management. Case Description: The patient initially presented in late 2017 with paroxysmal hypertension, diaphoresis, palpitations, and weight loss. Plasma normetanephrine was 499 pg/mL (ref <148), metanephrine 128 pg/mL (ref <57). CT abdomen showed a 1.7 × 1.5 cm left adrenal nodule. She declined further nuclear imaging and refused surgery. She was started on phenoxybenzamine 10 mg BID, which caused symptomatic hypotension. Switched briefly to doxazosin (up to 4 mg daily), she experienced recurrence of "episodes" by mid-2019 with home systolic BPs peaking at 190 mmHg. In September 2019, she resumed phenoxybenzamine (10 mg BID), improving BP to 124–128/76–80. By March 2020, phenoxybenzamine was increased to 10 mg TID; doxazosin 2 mg TID. Metoprolol was added but later changed to nebivolol. Clonidine 0.1 mg PRN was initiated in April 2023. By February 2024, she required 80 mg/day phenoxybenzamine (20 mg QID) due to hypertensive crises (SBP 200–220 mmHg) with disabling symptoms. BP stabilized by March 2024 (145/78). Kidney function remained stable throughout (creatinine 1.1–1.15 mg/dL; GFR 36–47). She underwent TAVR in November 2024 for worsening aortic stenosis. Her course was complicated by perioperative stroke and pneumonia, but she recovered. In May 2025, she remains at home under the care of her daughter, who monitors BP twice daily and coordinates closely with her nephrologist. Discussion: This case highlights the feasibility of long-term outpatient medical therapy in elderly patients with inoperable pheochromocytoma. Success hinged on individualized titration of alpha- and beta-blockers, home BP surveillance, and robust caregiver support. Despite age >90, CKD, and severe aortic stenosis, BP was largely controlled without surgical intervention. Conservative therapy may be a durable and effective alternative in select high-risk patients.