Abstract
We report a case of acute hypermetabolism following the induction of general anaesthesia in an 11-yr-old boy. This episode was diagnosed and managed as an acute malignant hyperthermia crisis. However, severe hypertension during the episode led to the discovery of an unsuspected phaeochromocy-toma. A hypermetabolic state during anaesthesia has several aetiologies, but correct diagnosis during the acute episode may be difficult.
Résumé
On rapporte le cas d’une crise augue d’ hypermétabolisme après l’induction de l’anesthesie générate chez un enfant de II ans. Cet épisode fut dianostiqué et traité comme une crise d’hyper-thermie maligne. Cependant l’hypertension sévère durant l’épisode a amené la découverte d’un phéochromocytome non diagnostiqué. Un état hypermétabolique durant l’anesthesie a plusieurs etiologies mais le diagnostic exact durant l’episode aigu peut etre difficile.
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References
Rosenberg H. Clinical presentation of malignant hypcrthermia. Br J Anaesth 1988; 60: 268–73.
Fletcher JE, Rosenberg H. Laboratory methods for malignant hypcrthermia diagnosis.In: Williams CH (Ed.), Experimental Malignant Hyperthermia. New York: Springer-Vcrlag, 1988; 121–40.
Kirkendall WM, Liechty RD, Culp DA. Diagnosis and treatment of patients with phaeochromocytoma. Arch Int Med 1965; 115: 529–36.
Kirby BD, Ham J, Fairley HB, Benowitz N, Schambelan M. Normotensive phaeochromocytoma: pharmacologic, paraneoplastic, and anaesthetic considerations. West J Med 1983; 139: 221–5.
Simon HB, Daniels GH. Hormonal hyprathermia: endocrinologic causes of fever. Am J Med 1979; 66: 257–63.
Madias NE, Goorno WE, Herson S. Severe lactic acidosis as a presenting feature of phaeochromocytoma. Am J Kid Dis 1987; 10: 250–3.
Bornemann M, Hill SC, Kidd GS. Lactic acidosis in phcochromocytoma. Ann Int Med 1986; 105: 880–2.
Keller U, Mall T, Walter M, Bertel O, Mihatsch JM, Rite R. Phaeochromocytoma with lactic acidosis. Br Med J 1978; 2: 606–7.
Steward DA. Malignant hyperthermia — the acute crisis. Int Anesthesiol Clin 1979; 17: 1–9.
Larach MG, Rosenberg H, Larach DR, Broennly AM. Prediction of malignant hyperthermia susceptibility by clinical signs. Ancsthcsiology 1987; 66: 547–50.
Gronert GA. Malignant hyperthermia.In: Miller RD (Ed.). Anesthesia, 2nd ed. New York: Churchill-Livingstone, 1986: 1971–94.
Kaufman BH, Telander RL, van Heerden JA, Zimmerman D, Sheps SG, Dawson B. Pheochromocytoma in the pediatric age group: current status. J. Ped Surgery 1983; 18: 879–84.
Crowley KJ, Cunningham AJ, Conroy B, O’Connell PR, Collins PG. Phaeochromocytoma — a presentation mimicking malignant hypcrthermia. Anaesthesia 1988; 43: 1031–2.
St. John Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma: review of a 50-year autopsy series. Mayo Clin Proc 1981; 56: 354–60.
Sloand EM, Thompson BT. Propranolol-induced pulmonary edema and shock in a patient with pheochromocytoma. Arch Int Med 1984; 144: 173–4.
Gilsanz FJ., Lucngo C, Conejero P, Peral P, Avello F. Cardiomyopathy and phaeochromocytoma. Anaesthesia 1983; 38: 888–91.
Sumikawa K, Hayashi Y, Fukumitsu K, Yoshiya I. Selective inhibition by dantrolene of caffeine-induced catecholaminc release from perfused dog adrenals. Res Commun Chcm Pathol Pharmacol 1987; 57: 45–53.
Rasmussen H. The calcium messenger system (part 2). N Engl J. Med 1986; 314: 1164–70.
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Allen, G.C., Rosenberg, H. Phaeochromocytoma presenting as acute malignant hyperthermia — a diagnostic challenge. Can J Anaesth 37, 593–595 (1990). https://doi.org/10.1007/BF03006334
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DOI: https://doi.org/10.1007/BF03006334