Pheochromocytoma Anesthetic Management

Abstract

Pheochromocytomas are catecholamine producing tumors and although uncommon present a great challenge to the anesthesiologist since it has nonspecific clinical symptoms and risk of critical events, including death when not previously diagnosed. Clinical manifestation is variable, unspecific and depends on the catecholamine production profile. The classic triad of headache, palpitation and diaphoresis is present in up to 70% of the cases and only 50% have sustained hypertension. The best approach for pheochromocytoma treatment is surgical excision of the affected adrenal gland. The introduction of alpha adrenergic blockade medication, such as phentolamine and phenoxybenzamine had the highest impact in perioperative mortality reduction due to inhibition of the deleterious effect of vasoconstriction. The majority of anesthetic techniques and drugs are considered safe. Post-operative care in intensive care unit is advisable since patients may present instability of blood pressure and hypoglycemia. Genetic testing should be done in first-degree relatives of confirmed cases or when a genetic syndrome is suspected.

Cardiac and Abdominal Pheochromocytomas: Anesthetic Management for a Combined Cardiac and Hepatobiliary Procedure

“…There are relatively little data published on the management of mediastinal pheochromocytomas; however, the treatment of choice is surgical resection, being curative in the majority of cases. 5,6 The authors' literature search revealed no published data to date discussing the anesthetic management of a secreting cardiac pheochromocytoma. Patients with a diagnosed pheochromocytoma usually are referred to an endocrine surgeon who often works with an anesthesiologist with expertise in the perioperative management of those patients.…”

Dexmedetomidine as an Ambulatory Sedation Agent for Abdominal MRI in Patients with Suspected Pheochromocytoma

“…Clinical signs and symptoms, biochemical testing, and radiographic testing are used to make the diagnosis. 5 In the anamnesis, we obtained complaints of dizziness and palpitations. On physical examination of the patient, it found sustained high blood pressure with no apparent cause.…”

Hypertensive crisis during spinal anesthesia due to undiagnosed pheochromocytoma

“…The stress of surgery and anesthesia can trigger hypertensive crises and other catecholamine-induced adverse events, leading to intraoperative mortality. [7] In our case, the differential diagnosis for the sudden intraoperative hypertensive crisis after tourniquet release included inadequate anesthesia, iatrogenic causes (e.g., accidental administration of vasopressors), severe hypercarbia, increased intracranial pressure (ICP), myocardial ischemia, bladder distension, thyroid storm, and pheochromocytoma. The patient did not report and discomfort or pain from the surgery making inadequate anesthesia or analgesia unlikely.…”