HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Myklejord, D. J. Search for Related Content PubMed PubMed Citation Articles by Myklejord, D. J.

Undiagnosed Pheochromocytoma: The Anesthesiologist Nightmare

Department of Anesthesiology, Marshfield Clinic, Marshfield, Wisconsin

REPRINT REQUESTS: Duane J. Myklejord, MD, Department of Anesthesiology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, Telephone: 715-387-7179, Fax: 715-389-3808, Email: myklejord.duane{at}marshfieldclinic.org

A male, 62 years of age, presented to the operating room for the removal of a right adrenal mass. Induction of anesthesia triggered a severe hypertensive crisis resistant to high doses of nitroprusside, nitroglycerin and labetalol. The crisis was ultimately resolved with the administration of 5 mg bolus of phentolamine. Surgery was canceled, the patient was transported to the intensive care unit with a continuous drip of phentolamine.

High urinary and plasma catecholamines suggested the presence of pheochromocytoma. Three weeks of oral phenoxybenzamine therapy subsequently allowed uneventful induction of anesthesia and open adrenalectomy. Pathologic examination of the resected adrenal tissue confirmed the presence of pheochromocytoma.

Anesthetic drugs can exacerbate the life-threatening cardiovascular effects of catecholamines secreted by pheochromocytomas. Treating patients preoperatively with -adrenergic blockade is helpful for reducing intraoperative hypertensive episodes. Postoperative administration of inotropic agents to correct hypotension due to catecholamine withdrawal may be required. Management of patients with pheochromocytoma remains a challenge for the anesthesiologist, despite the advent of new drugs and techniques.

Key Words: Pheochromocytoma • Anesthesia • Anesthesiology • Hypertensive crisis • Adrenal tumor • Phentolamine