Another Undiagnosed Pheochromocytoma Causes Hypertensive Crisis in the Operating Room—What about a Rapid Blood Metanephrine Test?

DOI: 10.4236/ojanes.2013.32023   PDF   HTML   XML   5,780 Downloads   8,136 Views  

Abstract

Undiagnosed pheochromocytoma is a cause of hypertension intraoperatively. Hypertension from pheochromocytoma catecholamine secretion is potentially fatal and requires immediate treatment with cardiac afterload reduction and preload augmentation for end-organ protection. Diagnosis and management in the acute period can be complex in the context of co-existing disease, other possible causes of hypertension, and the anesthetized patient who is unable to provide historical clues. This case report highlights the plausibility that pheochromocytomas may be more likely to present sub-clinically in elderly patients with severe vascular disease, so we suggest the potential utility of studying whether reduced vascular responsiveness is protective in any way to catecholamine load. Above all, as an increasing number of case reports of pheochromocytoma discovery intra-operatively emerge, many with catastrophic outcomes, the development value and feasibility of a rapid, on-site blood metanephrine test should be considered. Existing diagnostic methods of pheochromocytoma are relatively time-consuming and not useful in the acute situation.

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C. Rosenberg and R. Gomez, "Another Undiagnosed Pheochromocytoma Causes Hypertensive Crisis in the Operating Room—What about a Rapid Blood Metanephrine Test?," Open Journal of Anesthesiology, Vol. 3 No. 2, 2013, pp. 93-96. doi: 10.4236/ojanes.2013.32023.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] J. W. M. Lenders, G. Eisenhofer, M. Mannelli and K. Pacak, “Phaeochromocytoma,” Lancet, Vol. 366, No. 9486, 2005, pp. 665-675. doi:10.1016/S0140-6736(05)67139-5
[2] C. Prys-Roberts, “Phaeochromocytoma—Recent Progress in Its Management,” British Journal of Anaesthesia, Vol. 85, No. 1, 2000, pp. 44-57. doi:10.1093/bja/85.1.44
[3] G. Eisenhofer, H. J. Timmers, J. W. M. Lenders, S. R. Bornstein, et al., “Age at Diagnosis of Pheochromocytoma Differs According to Catecholamine Phenotype and Tumor Location,” Journal of Clinical Endocrinology and Metabolism, Vol. 96, No. 2, 2011, pp. 375-384.
[4] H. J. Holldack, “Induction of Anesthesia Triggers Hypertensive Crisis in a Patient with Undiagnosed Pheochromocytoma: Could Rocuronium Be to Blame?” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 21, No. 6, 2007, pp. 858-862. doi:10.1053/j.jvca.2006.11.007
[5] A. Dabbous, S. Siddik-Sayyid and A. Baraka, “Catastrophic Hemodynamic Changes in a Patient with Undiagnosed Pheochromocytoma Undergoing Abdominal Hysterectomy,” Anesthesia and Analgesia, Vol. 104, No. 1, 2007, pp. 223-224. doi:10.1213/01.ane.0000249812.87527.91
[6] O. F. Sellevold, J. Raeder and R. Stenseth, “Undiagnosed Phaeochromocytoma in the Perioperative Period. Case Reports,” Acta Anaesthesiologica Scandinavica, Vol. 29, No. 5, 1985, pp. 474-479.doi:10.1111/j.1399-6576.1985.tb02236.x
[7] M. Mannelli, J. W. Lenders, K. Pacak, G. Parenti and G. Eisenhofer, “Subclinical Phaeochromocytoma,” Best Practice & Research Clinical Endocrinology & Metabolism, Vol. 26, No. 4, 2012, pp. 507-515. doi:10.1016/j.beem.2011.10.008
[8] D. J. Myklejord, “Undiagnosed Pheochromocytoma: The Anesthesiologist Nightmare,” Journal of Clinical Medicine Research, Vol. 2, No. 1, 2004, pp. 59-62. doi:10.3121/cmr.2.1.59
[9] K. J. Crowley, A. J. Cunningham, B. Conroy, P. R. O’Connell and P. G. Collins, “Phaeochromocytoma—A Presentation Mimicking Malignant Hyperthermia,” Anaesthesia, Vol. 43, No. 12, 1988, pp. 1031-1032. doi:10.1111/j.1365-2044.1988.tb05703.x
[10] U. Sartipy, J. Lindvall, J. Van Der Linden and G. Dellgren, “Successful of Pump Coronary Bypass Grafting in a Patient with an Undiagnosed Pheochromocytoma,” Acta Anaesthesiol Scand, Vol. 47, No. 8, 2003, pp. 1044-1046. doi:10.1034/j.1399-6576.2003.00191.x
[11] M. Bensghir, A. Elwali, S. J. Lalaoui, N. D. Kamili, H. Alaoui, J. Laoutid, H. Azendour, H. Balkhi, C. Haimeur and M. Atmani, “Management of Undiagnosed Pheochromocytoma with Acute Appendicitis,” World Journal of Emergency Surgery, Vol. 15, No. 4, 2009, p. 35.doi:10.1186/1749-7922-4-35
[12] S. Lewis, M. Dirnhuber and J. Soar, “An Unusual Presentation of a Pheochromocytoma,” J Cardiothorac Vasc Anesth, Vol. 20, No. 3, 2006, pp. 390-393. doi:10.1053/j.jvca.2005.03.029
[13] G. C. Allen and H. Rosenberg, “Phaeochromocytoma Presenting as Acute Malignant Hyperthermia—A Diagnostic Challenge,” Canadian Journal of Anesthesia, Vol. 37, No. 5, 1990, pp. 593-595. doi:10.1007/BF03006334
[14] T. T. Christensen, J. Frystyk and P. L. Poulsen, “Comparison of Plasma Metanephrines Measured by a Commercial Immunoassay and Urinary Catecholamines in the Diagnosis of Pheochromocytoma,” Scandinavian Journal of Clinical & Laboratory Investigation, Vol. 71, No. 8, 2011, pp. 695-700. doi:10.3109/00365513.2011.622410
[15] P. E Hickman, M. Leong, J. Chang, S. R. Wilson and B. McWhinney, “Plasma Free Metanephrines Are Superior to Urine and Plasma Catecholamines and Urine Catecholamine Metabolites for the Investigation of Phaeochromocytoma,” Pathology, Vol. 41, No. 2, 2009, pp. 173-177.
[16] N. Unger, T. Deutschbein, M. K. Walz, K. Mann and S. Petersenn, “The Value of Immunoassays for Metanephrines in the Biochemical Diagnosis of Pheochromocytomas,” Hormone and Metabolic Research, Vol. 41, No. 9, 2009, pp. 676-679. doi:10.1055/s-0029-1224133
[17] K. J. Joo-Ching, Au V. Shu-Chuan and C. R. Yuan-Tud, “Recurrent Urosepsis and Cardiogenic Shock in an Elderly Patient with Pheochromocytoma,” Case Reports in Endocrinology, Vol. 2011, 2011. Article ID 759523. doi:10.1155/2011/759523
[18] J. W. Lenders, K. Pacak, M. M. Walther, W. M. Linehan, M. Mannelli, P. Friberg, H. R. Keiser, D. S. Goldstein and G. Eisenhofer, “Biochemical Diagnosis of Pheochromocytoma: Which Test Is Best?” Journal of American Medical Association, Vol. 287, No. 11, 2002, pp. 1427-1434. doi:10.1001/jama.287.11.1427

  
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