An Undiagnosed Intraoperative Pheochromocytoma
A 35-year-old Caucasian female presented to the operating room for a left adrenalectomy. She initially presented to the emergency department with abdominal and left-sided shoulder pain. A CT scan showed a very large (18.0 × 17.3 × 21.1 cm) left adrenal mass, and she was scheduled for a left adrenalectomy. It was believed to be a benign neoplasm of adrenal origin per the surgical team. Intraoperatively, she experienced significant hypertension and tachycardia unresponsive to narcotics and deepening of anesthesia, eventually requiring antihypertensive medications. Almost immediately upon surgical removal, the hypertension and tachycardia improved. The patient was successfully extubated and was subsequently discharged a few days later. Further testing revealed it to be a pheochromocytoma with biologically aggressive behavior. This case demonstrates the importance of adequate preparation for the possibility of an undiagnosed pheochromocytoma when dealing with adrenal mass removals.
KeywordsUndiagnosed pheochromocytoma Adrenal mass Symptom-based diagnosis Anesthetic considerations Preoperative management Management Postoperative management Hypertension Tachycardia
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