Restricted accessResearch articleFirst published online 2018-9
Intraoperative Hemodynamic Instability and Diagnosis of Pheochromocytoma During Excision of Adrenal Incidentaloma With Incomplete Workup: A Case Report
Preoperative evaluation of incidentalomas for pheochromocytoma is imperative. This case report describes a scheduled adrenalectomy in an asymptomatic patient with what was eventually determined to be an incomplete biochemical workup. The intraoperative course was complicated by labile and rapid increases in blood pressure and heart rate, suggesting the missed diagnosis of pheochromocytoma. It is important for anesthesiologists to ensure adequate preoperative biochemical workup before excluding the possibility of coexisting pheochromocytoma.
GrumbachMMBillerBMBraunsteinGDet al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med. 2003;138:424-429.
2.
PrejbiszALendersJWEisenhoferGJanuszewiczA.Mortality associated with phaeochromocytoma. Horm Metab Res. 2013;45:154-158.
3.
BaquetJPHammerLMazzucoTLet al. Circumstances of discovery of pheochromocytoma: a retrospective study for 41 consecutive patients. Eur J Endocrinol. 2004;150:681-686.
4.
DobriGABravoEHamrahianAH.Pheochromocytoma: pitfalls in biochemical evaluation. Expert Rev Endocrinol Metab. 2014;9:123-135.
5.
KannanSRemerEMHamrahianAH.Evaluation of patients with adrenal incidentalomas. Curr Opin Endocrinol Diabetes Obes. 2013;20:161-169. doi:10.1097/MED.0b013e328360a43b.
6.
HéronEChatellierGBillaudEFoosEPlouinPF.The urinary metanephrine-to-creatinine ratio for the diagnosis of pheochromocytoma. Ann Intern Med. 1996;125:300-303.
7.
KiernanCMSolórzanoCC.Pheochromocytoma and paraganglioma: diagnosis, genetics, and treatment. Surg Oncol Clin N Am. 2016;25:119-138. doi:10.1016/j.soc.2015.08.006.
CawoodTJHuntPJO’SheaDColeDSouleS.Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?Eur J Endocrinol. 2009;161:513-527. doi:10.1530/EJE-09-0234.
10.
YuRWeiM.False positive test results for pheochromocytoma from 2000 to 2008. Exp Clin Endocrinol Diabetes. 2010;118:577-585.
11.
HariskovSSchumannR.Intraoperative management of patients with incidental catecholamine producing tumors: a literature review and analysis. J Anaesthesiol Clin Pharmacol. 2013;29:41-46.doi:10.4103/0970-9185.105793.
12.
AgrawalRMishraSKBhatiaEet al. Prospective study to compare peri-operative hemodynamic alterations following preparation for pheochromocytoma surgery by phenoxybenzamine or prazosin. World J Surg. 2014;38:716-723.
13.
WachtelHKennedyEHZaheerSet al. Preoperative metyrosine improves cardiovascular outcomes for patients undergoing surgery for pheochromocytoma and paraganglioma. Ann Surg Oncol. 2015;22:S646-S654.doi:10.1245/s10434-015-4862-z.
14.
ShaoYChenRShenZJet al. Preoperative alpha blockade for normotensive pheochromocytoma: is it necessary?J Hypertens. 2011;29:2429-2432. doi:10.1097/HJH.0b013e32834d24d9.
15.
LivingstoneMDuttchenKThompsonJet al. Hemodynamic stability during pheochromocytoma resection: lessons learned over the last two decades. Ann Surg Oncol. 2015;22:4175-4180. doi:10.1245/s10434-015-4519-y.
