Hypertensive Crisis Due to Pheochromocytoma

Abstract

Pheochromocytomas are rare neuroendocrine tumors of the adrenal medulla, which may store excessive amounts of catecholamines. Hypertensive crisis is a feared and potentially fatal complication of pheochromocytoma, which may be precipitated by tumor manipulation, certain medications, and noxious stimuli. Emergent surgery should not be considered appropriate first-line treatment for a hypertensive crisis, as it may result in dangerous complications. The key to prevention and treatment of a crisis is diagnosis and adherence to consensus guidelines for preoperative alpha-receptor blockade, primarily phenoxybenzamine or doxazosin, for 10–14 days prior to surgery. Careful intraoperative monitoring of blood pressure and volume status is required. The laparoscopic, including robotic-assisted laparoscopic, adrenalectomy has evolved as the mainstay of surgical treatment. Meticulous surgical technique, with minimal tumor manipulation and early ligation of the adrenal vein, should be employed. Management of a hypertensive crisis requires rapid administration and careful titration of quick-acting vasodilators, including sodium nitroprusside and nitroglycerin. Attention should be given to alternative agents, including magnesium, clevidipine, and vasopressin.