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Published on: September 15, 2017
Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma
Gina Song1, Bonnie N Joe, Benjamin M Yeh
1Department of Radiology, University of California, San Francisco, CA, USA.
Purpose:
To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma.
Materials And Methods:
Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation.
Results:
None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct.
Conclusion:
Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.
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