Abstract
A 35-year-old Caucasian female presented to the operating room for a left adrenalectomy. She initially presented to the emergency department with abdominal and left-sided shoulder pain. A CT scan showed a very large (18.0 × 17.3 × 21.1 cm) left adrenal mass, and she was scheduled for a left adrenalectomy. It was believed to be a benign neoplasm of adrenal origin per the surgical team. Intraoperatively, she experienced significant hypertension and tachycardia unresponsive to narcotics and deepening of anesthesia, eventually requiring antihypertensive medications. Almost immediately upon surgical removal, the hypertension and tachycardia improved. The patient was successfully extubated and was subsequently discharged a few days later. Further testing revealed it to be a pheochromocytoma with biologically aggressive behavior. This case demonstrates the importance of adequate preparation for the possibility of an undiagnosed pheochromocytoma when dealing with adrenal mass removals.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Sabatine S, Marc MD. Pocket medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2011. Print
Barash PG. Clinical anesthesia. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013. p. 1334–42. Print
Ramakrishna H. Pheochromocytoma resection: current concepts in anesthetic management. J Anaesthesiol Clin Pharmacol. 2015;31(3):317–23. PubMed. Web. 20 Oct 2016
Ilias I, Pacak K. A clinical overview of pheochromocytomas/paragangliomas and carcinoid tumors. Nucl Med Biol. 2008;35(Suppl 1):S27–34.
Butterworth JF, Mackey DC, Wasnick JK, editors. Morgan and Mikhail’s clinical anesthesiology. 5th ed. New York: The McGraw-Hill Companies, Inc.; 2013.
Pourian M, Mostafazadeh DB, Soltani A. Does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2015;15:6.
Mulholland MW. Greenfield’s surgery: scientific principles and practice. In: Lillemoe KD, Doherty GM, Maier RV, editors. Adrenal gland. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
Yao F-SF, Malhotra V, Fontes ML. Endocrine system: pheochromocytoma, Yao & Artusio’s Anesthesiology: Problem-Oriented Patient Management. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012. p. 501–11. Print
Eisenhofer G, Peitzsch M. Laboratory evaluation of pheochromocytoma and paraganglioma. Clin Chem. 2014;60(12):1486–99.
Curran MP, Robinson DM, Keating GM. Intravenous nicardipine its use in the short-term treatment of hypertension and various other indications. Drugs. 2006;66(13):1756–82. Web
Phentolamine. PubChem. National Center for Biotechnology Information, n.d. Web. 1 Dec 2016. https://pubchem.ncbi.nlm.nih.gov/compound/phentolamine#section=Top.
Nitroglycerin. Pubchem. National Center for Biotechnology Information, n.d. Web. 1 Dec 2016. https://pubchem.ncbi.nlm.nih.gov/compound/4510.
Nitroprusside. Pubchem. National Center for Biotechnology Information, n.d. Web. 1 Dec 2016. https://pubchem.ncbi.nlm.nih.gov/compound/11963622.
Propranolol. PubChem. National Center for Biotechnology Information., n.d. Web. 1 Dec 2016. https://pubchem.ncbi.nlm.nih.gov/compound/4946.
Esmolol. PubChem. National Center for Biotechnology Information., n.d. Web. 1 Dec 2016. https://pubchem.ncbi.nlm.nih.gov/compound/59768.
LABETALOL HYDROCHLORIDE INJECTION USP. Product Monograph. Sandoz Canada Inc, 23 Aug 2011. Web. 1 Dec 2016. http://www.sandoz.ca/cs/groups/public/@sge_ca/documents/document/n_prod_1301125.pdf.
Chan GM, Sharma R, Price D, Hoffman RS, Nelson LS. Phentolamine therapy for cocaine-association acute coronary syndrome (CAACS). J Med Toxicol. 2006;2(3):108–11.
Hollander JE, Henry TD. Evaluation and management of the patient who has cocaine-associated chest pain. Cardiol Clin. 2006;24(1):103–14.
Tuncel M, Ram VC. Hypertensive emergencies. Etiology and management. Am J Cardiovasc Drugs. 2003;3(1):21–31.
Maccarthy EP, Bloomfield SS. Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. Pharmacother: J Hum Pharmacol Drug Ther. 1983;3(4):193–217.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Jensen, B.B., Herway, S. (2019). An Undiagnosed Intraoperative Pheochromocytoma. In: Benumof, J., Manecke, G. (eds) Clinical Anesthesiology II. Springer, Cham. https://doi.org/10.1007/978-3-030-12365-9_13
Download citation
DOI: https://doi.org/10.1007/978-3-030-12365-9_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-12363-5
Online ISBN: 978-3-030-12365-9
eBook Packages: MedicineMedicine (R0)