An unusual presentation of a pheochromocytoma.

摘要

PHEOCHROMOCYTOMA is a rare endocrine tumor that accounts for about 0.04% of all cases of hypertension.1 Clinical presentation depends on the pattern of catecholamine secretion by the tumor. Norepinephrine-secreting tumors usually manifest with severe sustained hypertension. Patients with predominantly epinephrine-secreting tumors have paroxysmal symptoms of palpitations, panic attacks, and diaphoresis. Other less widely recognized findings include pulmonary edema, cerebrovascular accident, and catecholamine-induced cardiomyopathy. Perioperative presentation does occur, and has been described as occurring at induction of anesthesia, intra-operatively with surgical stimulation and manipulation, and postoperatively after propranolol administration.The authors report the case of a pheochromocytoma occurring after external palpation of the anesthetized patient's abdomen. Previous examinations in the awake state had been unremarkable. Labetalol was initially given to treat the hypertensive crisis. Pulmonary edema and reversible catecholamine-induced cardiomyopathy developed. A pulmonary artery flotation catheter proved invaluable in managing the cardiovascular instability during the crisis. The perioperative findings and rarer sequelae of pheochro-mocytomas, and their subsequent management, are discussed.