Clinical Autonomic Research

, Volume 4, Issue 4, pp 167–173

Phaeochromocytoma: Intraoperative changes in blood pressure and plasma catecholamines

  • Anne L. Tonkin
  • Derek B. Frewin
  • W. John Russell
  • Julie R. Jonsson
Research Paper


The aim of this study was to assess the relationship between changes in plasma catecholamine concentrations and intraarterial blood pressure (BP) measured simultaneously during resection of phaeochromocytoma (n = 14). Arterial plasma concentrations of noradrenaline (NA), adrenaline (A) and dopamine (DA) were measured by a radio-enzymatic method. Arterial NA concentrations (pmol/ml; median and Wilcoxon 95% CI) were 71.8 (46,162) before induction of anaesthesia, 113.0 (79,231) after intubation, 375.0 (285,931) during tumour handling and 32.5 (18,88) following tumour removal. Simultaneous mean BP values (mmHg; Mean ± SEM) were 119 ± 8, 114 ± 7, 159 ± 7 (p = 0.0001) and 72 ± 6 (p < 0.0001) respectively. At the time of tumour handling there was a weak correlation between plasma NA and A combined and mean BP (r = 0.583,p = 0.029) and a stronger correlation between log plasma NA and A combined and pulse pressure (r = 0.749,p = 0.008). The very large rises in plasma catecholamine concentrations and in BP are likely to have been causally related. Individual patients maintained a constant ratio of NA to A in plasma from pre-induction to tumour handling (r = 0.916,p < 0.0001). The maintenance of a constant NA: A ratio suggests that the pattern of catecholamine synthesis and release may be a characteristic of the individual tumour.

Key words

Phaeochromocytoma Catecholamines Blood pressure Hypertension Anaesthesia 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hartley L, Perry-Keene D. Phaeochromocytoma in Queensland — 1970–1983.Aust NZ J Surg 1985;55: 471–475.Google Scholar
  2. 2.
    Januszewicz W, Wocial B. Clinical and biochemical aspects of phaeochromocytoma. Report of 110 cases.Cardiology 1985;72 (suppl 1): 131–136.PubMedGoogle Scholar
  3. 3.
    Muneta S, Kawada H, Iwata T, Murakami E, Hiwada K. Impairment of baroreceptor reflex in patients with phaeochromocytoma.J Hum Hypertens 1992;6: 77–78.PubMedGoogle Scholar
  4. 4.
    Robertson D, Hollister AS, Biaggioni I, Netterville JL, Mosqueda-Garcia R, Robertson RM. The diagnosis and treatment of baroreflex failure.N Engl J Med 1993;329: 1449–1455.PubMedGoogle Scholar
  5. 5.
    Greaves DJ, Barrow PM. Emergency resection of phaeochromocytoma presenting with hyperamylasaemia and pulmonary oedema after abdominal trauma.Anaesthesia 1989;44: 841–842.PubMedGoogle Scholar
  6. 6.
    Desmonts JM, Marty J. Anaesthetic management of patients with phaeochromocytoma.Br J Anaesth 1984;56: 781–789.PubMedGoogle Scholar
  7. 7.
    Jones DH, Reid JL, Hamilton CA, Allison DJ, Welbourn RB, Dollery CT. The biochemical diagnosis, localization and followup of phaeochromocytoma: the role of plasma and urinary catecholamine measurements.Q J Med 1980;49: 341–361.PubMedGoogle Scholar
  8. 8.
    Gröndal S, Eriksson B, Hamberger B, Theodorsson E. Plasma chromogranin A+B, neuropeptide Y and catecholamines in pheochromocytoma patients.J Intern Med 1991;229: 453–456.PubMedGoogle Scholar
  9. 9.
    Frewin DB, Jamieson GG, Russell WJ, Chatterton BE, Ropiha C, Boundy KL, Jonsson JR. Extra-adrenal phaeochromocytoma: report of three interesting cases.Aust NZ J Surg 1989;59: 691–695.Google Scholar
  10. 10.
    Cummings MF, Russell WJ, Frewin DB. The effect of pancuronium and alcuronium on the changes in arterial pressure and plasma catecholamine concentration during tracheal intubation.Br J Anaesth 1983;55: 619–623.PubMedGoogle Scholar
  11. 11.
    DaPrada M, Zürcher G. Simultaneous radioenzymatic determination of plasma and tissue adrenaline, noradrenaline and dopamine within the femtomole range.Life Sci 1976;19: 1161–1169.PubMedGoogle Scholar
  12. 12.
    Takeda R, Yasuhara S, Miyamori I, Sato T, Miura Y. Phaeochromocytoma in Japan: analysis of 493 cases during 1973–1982.J Hypertension 1986;4 (suppl 5): S397-S399.Google Scholar
  13. 13.
    Bachmann AW, Hawkins PG, Gordon RD. Phaeochromocytomas secreting adrenaline but not noradrenaline do not cause hypertension and require precise adrenaline measurement for diagnosis.Clin Exp Pharmacol Physiol 1989;16: 275–279.PubMedGoogle Scholar
  14. 14.
    Grouzmann E, Comoy E, Bohuon C. Plasma neuropeptide Y concentrations in patients with neuroendocrine tumors.J Clin Endocrinol Metab 1989;68: 808–813.PubMedGoogle Scholar
  15. 15.
    Krause M, Reinhardt D, Kruse K. Phaeochromocytoma without symptoms: desensitization of the alpha-and beta-adrenoceptors.Eur J Pediatr 1988;147: 121–122.PubMedGoogle Scholar
  16. 16.
    Hu Z, Azhar S, Hoffman BB. Prolonged activation of alpha 1 adrenoceptors induces down-regulation of protein kinase C in vascular smooth muscle.J Cardiovasc Pharmacol 1992;20: 982–989.PubMedGoogle Scholar
  17. 17.
    Stenstrom G, Haljamae H, Tisell L-E. Influence of pre-operative treatment with phenoxybenzamine on the incidence of adverse cardiovascular reactions during anaesthesia and surgery for phaeochromocytoma.Acta Anaesthesiol Scand 1985;29: 797–803.PubMedGoogle Scholar
  18. 18.
    Russell WJ, Kaines AH, Hooper MJ, Frewin DB. Labetalol in the preoperative management of phaeochromocytoma.Anesth Intens Care 1982;10: 160–163.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1994

Authors and Affiliations

  • Anne L. Tonkin
    • 1
  • Derek B. Frewin
    • 1
  • W. John Russell
    • 2
  • Julie R. Jonsson
    • 1
  1. 1.Department of Clinical and Experimental PharmacologyUniversity of AdelaideAdelaideAustralia
  2. 2.Department of Anaesthesia and Intensive CareUniversity of AdelaideAdelaideAustralia

Personalised recommendations