A study of 138 cases of pheochromocytoma encountered at the Mayo Clinic in the years 1926 to 1970 is presented. Of the 138 patients, 63 were males and 75 were females. Their ages ranged from 3 to 78 years with a peak incidence in the fifth decade of life. Hypertension was present in 91% of patients. Symptoms and signs were reported but did not correlate with size, distribution, and location of tumor. The incidence of bilaterality was 4.8%, of extra-adrenal tumors 10%, and of malignancy 13.1%. The diagnostic method used was the determination of metanephrine in 24-hour collections of urine. Nephrotomography was extremely helpful in diagnosis with an accuracy rate of 67.4% for adrenal tumors. The surgical mortality in this series was 2.9%; the recurrence rate after surgical treatment was 9.8% and the 5-year survival subsequent to treatment for the benign tumors was 96% and for malignant tumors, 44%. The actuarial survival curve for patients with benign tumors was similar to that of the normal population, while the curve for malignant tumors showed a significant decrease in survivalship when compared to that of the normal population.UR KNOWLEDGE OF PHEOCHRONIOCYTOMA has undergone considerable expansion since Dr. Charles Mayo performed the first resection of such a tumor in 1926.14 Today these functional chromaffin-tissue tumors are best diagnosed by biochemical methods that quantitate catecholamine production and its degradation products such as vanillylmandelic acid (VMA), metanephrine, and normetanephrine.In the present study, further observations were made on the accuracy of various diagnostic methods 1,2,6,9,20,24,25 in current use, the pathologic behavior of these tumors, and the long-term survival of patients after treatment for localized or benign and metastatic or malignant pheochromocytomas. (24-hour urinary vanillylmandelic acid, metanephrine, normetanephrine, and catecholamines) were tabulated both before and after operation. Followup was on an annual basis. Patients who were operated on more than 3 years prior to the study, who were asymptomatic and doing well, and who were unable to return for followup examination were requested to mail a 24-hour specimen of urine for biochemical analyses.The pathologic sections were reviewed by one of us (E.G.H.), and criteria used to separate malignant from benign tumors were based on proved metastasis to nonchromaffin tissues since cytologic features could not separate those neoplasms that were more aggressive. Data from the entire group of 138 patients, 18 of whom had malignant disease, form the basis of this report.Patients were traced by interviews or by letters. Six patients were lost to followup 1, 1, 1, 4, 6, and 10 years after treatment. The shortest followup was 1 year and the longest was 24 years.Age and Sex Over the 44-year period, 138 patients with pheochromocytoma were operated upon at this clinic, 63 (45.6%) of whom were male and 75 (54.4%) female. Iley ranged in age from 3 to 78 years with a median distribution of 740