Emergency operation in a patient with asymptomatic pheochromocytoma

Abstract

Intraoperative care of the patients with pheochromocytorna presents many difficult problems in anesthetic mariagement-. There are some patients who show no definite clinical symptoms, so-called "asymptomatic pheochromocytoma"~~H. Recent advances in techniques of computed tomography (CT) and magnetic resonance imaging (MRI) have increased an opportunity of the incidental discovery of retroperitoneal tumors, in the absence of clinical symptoms. We experienced a case of asymptomatic pheochromocytoma associated with sudden hypertension and tachycardia following surgical manipulation. Case ReportA 68-year-old man, weighing 37 kg and 150 ern tall, presented with appetite loss. Routine laboratory tests revealed hypercalcemia (13.1 mg·dl-\ normal range 9.1~10.6 mg·dl-1 ) and slight anemia (Hb 9.2 g-dl-1 , normal range 13.3-17.0 g.dl-1 ) . He was admitted to our hospital for further investigation of hypercalcemia. He had a medical history of acute subdural hematoma 4 years ago resulting in left hemiparesis. CT finding of the abdomen demonstrated a mass with necrosis at a left supraadrenal lesion. An aortic angiogram showed that the tumor was originated from the left adrenal gland artery. This suggested a possible case of pheochromocytoma but he presented no complaints of hypertension, palpitations, headache or sweating. Blood pressrue (BP) and heart rate (HR) were within the normal range. The functions of the thyroid, pancreatic islet cells, adrenal cortex and pituitary gland were also within the normal range. Electrocardiogram showed slight depressions of the ST-segment on V1-V G leads. Subsequent to admission, the patient was febrile to 38.5°C for several days. White cell counts were within the normal range, but monocytes increased. Blood and urine cultures were obtained, and intravenous broadspectrum antibiotics were started. In view of the rapid deterioration of this patient, an emergency operation was planned to remove the mass, which was thought to include an infectious lesion. Serum and urinary catecholamines were examined, but the results had not been returned yet.He was premedicated with scopo-