Pheochromocytoma Crisis Presenting With ARDS Successfully Treated With ECMO-Assisted Adrenalectomy

Abstract

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Case Report: Surgical Intervention Under Pheochromocytoma Multisystem Crisis: Timing and Approach

“…However, in the case of life-threatening PMC with extreme hemodynamic fluctuations, emergency surgery may achieve hemodynamic stabilization rapidly ( 1 , 2 , 14 , 15 ). In addition, surgery with ECMO support will improve the safety of the procedure ( 6 , 7 , 16 ). Delayed surgery may have a risk of recurrent crises, further organ failure, and more complications ( 7 ).…”

“…We performed a search of the English literature and identified 13 patients who presented with PMC and received emergency pheochromocytoma resection after 2010. All these patients were alive, including 4 who underwent surgery with the support of ECMO ( 1 , 2 , 6 , 7 , 14 , 15 ). Furthermore, we extracted literature with specific data ( Table 1 ).…”

“…After multidisciplinary discussions, an emergency left adrenalectomy with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support was decided. Because of the trauma of open surgery and literature reports ( 6 ), we chose to use the laparoscopy approach first and prepared to open on the 28th day ( Figure 2E ). Pathology confirmed pheochromocytoma with hemorrhage, and plasma MN levels returned to normal ranges (metanephrine, 95.26 ng/L; normetanephrine, 118.99 ng/L).…”

“…However, progressive multiple organ failures still occur in some patients despite the use of α-blockade and β-blockade. Emergency adrenalectomy may lead to rapid hemodynamic stabilization and recovery, even though some are extracorporeal membrane oxygenation (ECMO)-assisted emergency adrenalectomy ( 2 , 6 , 7 ). However, the optimal timing of surgery under PMC remains controversial ( 2 , 8 ).…”

“…However, the optimal timing of surgery under PMC remains controversial ( 2 , 8 ). Minimally invasive surgery (laparoscopic or robotic) is considered the preferred surgical technique for small (<6 cm), non-invasive pheochromocytoma ( 1 , 4 ); however, whether the laparoscopic approach suits patients with PMC also remains controversial ( 6 ). We present two cases combined with a literature review to determine the optimal timing and approach for surgery with unstable PMC.…”