Asymptomatic Pheochromocytoma Interpreted as Non-Functioning Incidentaloma: A Major Challenge: Case Report and Review
Journal Title: Enliven: Journal of Anesthesiology and Critical Care Medicine - Year 2015, Vol 2, Issue 9
Abstract
Introduction Adrenal incidentaloma (AI) is a result of easy availability of imagiological diagnostic techniques and may include many primary, metastatic, benign, and malignant entities, the majority of which are benign and nonfunctioning adrenal adenomas. However to 7% prove to be pheochromocytomas. Case Report 38 year old male with right adrenal adenoma associated co-morbidity was pre-diabetic without symptoms suggesting pheochromocytoma, biochemically with a borderline increase on urinary norepinephrine. He was proposed for laparoscopic right adrenalectomy with no preoperative pharmacological preparation. Intra operatively, the tumor manipulation resulted in manifestations typical of pheochromocytoma, refractory to treatment, with biochemical signs of myocardial ischemia. Discussion Usual recommendations are on favor of measuring plasma and urinary fractionated metanephrines in all patients with adrenal incidentaloma, this evaluation should be complemented with imagiological findings. There is no universal consensus on when to start preoperative preparation, in which patients or which pharmacological scheme should be used. Conclusion Based upon ours and reported experience, we recommend that every asymptomatic patient with adrenal mass and biochemical evaluation suggestive of pheochromocytoma should be preoperatively submitted to alpha-antagonism to avoid potentially life threatening hemodynamic fluctuations on intraoperative and postoperative period
Authors and Affiliations
Araújo Rita, Marques Celine, Rodrigues Mariana, Paulino Ana, Luís Campos
Keywords
Related Articles
- EP ID EP619156
- DOI -
- Views 116
- Downloads 0
Stellate Ganglion Block Reduces the Radicular Pain and Salivary Alpha-Amylase Activity in Patients with Cervical Spondylosis
Background The effects of stellate ganglion block (SGB) on radicular pain associated with cervical spondylosis remain to be clarified. So we measured salivary alpha-amylase which reflects sympathetic nerve activity under...
Plateau Waves, Intracranial Hypertension and Prognosis. How Identical Waves can Lead to Different Outcomes in Two Patients with Traumatic Brain Injury
Elevated intracranial pressure (ICP) can lead to secondary brain damage and is associated with worst outcome in patients with traumatic brain injury. We present two clinical cases of high ICP due plateau waves. This, fre...
Minimum Alveolar Concentration Needed to Block Adrenergic Response of Sevoflurane with Nitrous Oxide Varies Depending on the Stimulation Sites in Adult Surgical Patients
Background We examined whether minimum alveolar anesthetic concentration needed to block adrenergic response (MAC-BAR) of sevoflurane with nitrous oxide (N2O) varies depending on body surface sites to which noxious stimu...
Patient with Eisenmenger's Syndrome and Severe Progressive Kyphoscoliosis presents for Posterior spinal fusion
A fourteen year old male patient with Eisenmenger’s syndrome (ES) and severe, progressive kyphoscoliosis presented for posterior spinal fusion, T2-L2. A thorough, preoperative evaluation and multidisciplinary conference...
Surgery on Obese Patient under Infusion with Dexdor
Numerous studies have demonstrated that the drugs currently used for sedation are associated with adverse events, particularly when combined with opiates. Regardless of the agent or agents used, it is important to monito...