[Anesthetic management of undiagnosed pheochromocytoma: a case report]

A 55-year-old man was scheduled for resection of an adrenal tumor under the diagnosis of a non-functioning adrenal tumor. He was admitted for unstable angina 58 days preoperatively, and on the second hospital day, he had an episode of ventricular tachycardia for 20 seconds following epigastric pain. Abdominal computed tomography scans revealed a retroperitoneal abscess, which was subsequently drained effectively, and a right adrenal tumor. Because of the almost normal plasma catecholamine concentration, the tumor was considered a nonfunctioning tumor. However, when the surgeon manipulated the tumor during the operation, the patient's blood pressure increased suddenly to 240/120 mmHg. The hypertensive crisis was managed with nicardipine and phentolamine. After resection of the tumor, his blood pressure decreased to 80/40 mmHg, and the patient was treated with ephedrine, phenylephrine, and noradrenaline. After surgery, the tumor was confirmed histopathologically as a pheochromocytoma. The management of patients with a hypertensive crisis under suspicion of pheochromocytoma is discussed.