Author/Editor     Ivanova, E; Požar-Lukanovič, N; Pegan, V
Title     Severe intraoperative hypertension caused by unsuspected pheochromocytoma - a case report
Type     članek
Source     In: Zabavnik Z, editor. Book of lectures of the 16th anaesthesia symposium Alpe Adria; 2003 May 9-11; Maribor. Maribor: Splošna bolnišnica,
Publication year     2003
Volume     str. 49-52
Language     eng
Abstract     Pheochromocitoma is a rare neuroendocrine tumor with catecholamine secretion. If undiagnosed before surgery for other disease, it may cause dangerous increases of blood pressure with potentially serious consequences. Our patient, a 46 years old woman without history of hypertension, was planned for cholecystectomy and exploration of asymptomatic retroperitoneal tumor that had been found in preoperative CT scan (near the aorta and vena cava inferior in the level of the lower pole of the right kidney). Anaesthetic treatment consisted of combination of general and thoracic epidural anaesthesia. After induction of anaesthesia, on surgical manipulation of the tumor, systolic blood pressure raised up to 270 mm Hg. It was treated with esmolol i.v. boluses and increased anaesthesia depth. After isolation of the tumor from the circulation the patient blood pressure decreased, so hypotension was treated with i.u. fluids and ephedrine. During hypertensive episode, a possibility of pheochromocitoma was suspected and urine sample was taken to determinate catecholamine metabolites. Normal levels of metanephrine, borderline levels of vanillylmandelic acid (VMA) and 5- fold increase of normetanephrine were found. Histological examination revealed extraadrenal paraganglioma and confirmed our diagnosis. Postoperative course of the patient was unremarkable. Further examinations were not able to find any other ectopic location of neuroendocrine tissue. We concluded that sudden extreme elevations of blood pressure , when high levels of anaesthesia are ruled out, rise suspicion of undiagnosed pheochromocytoma and should lead to rapid treatment.
Descriptors     PHEOCHROMOCYTOMA
HYPERTENSION
CHOLECYSTECTOMY
ANESTHESIA
MIDDLE AGE