[Hyperlactemia during undiagnosed pheochromocytoma resection under laparoscopy]
Masashi Fujii1, Yasuyo Kawabata, Tomoko Hayashi
1Department of Anesthesia, Hikone Municipal Hospital, Hikone 522-8539.
Masui. the Japanese Journal of Anesthesiology
|March 15, 2012
Summary
Pheochromocytoma can cause high blood lactate levels, even with normal initial tests. This case highlights hyperlactemia as a key indicator of pheochromocytoma during surgery.
Area of Science:
- Anesthesiology
- Endocrinology
- Oncology
Background:
- Adrenal tumors are often diagnosed based on hormonal activity and patient presentation.
- Nonfunctional adrenal tumors typically do not cause significant hemodynamic changes during resection.
- Anesthesia management for adrenal tumor resection requires careful monitoring of vital signs.
Observation:
- A patient undergoing adrenal tumor resection experienced sudden increases in blood pressure and heart rate.
- Initial laboratory tests and hormone levels did not suggest a functional tumor.
- Persistent hyperlactemia was observed despite hemodynamic stabilization with landiolol and prostaglandin E1.
Findings:
- Postoperative analysis revealed extremely high intraoperative plasma adrenaline concentrations.
- Adrenaline's metabolic effects were identified as the cause of elevated blood lactate.
- Hyperlactemia was confirmed as a potential, often overlooked, symptom of pheochromocytoma.
Implications:
- This case underscores the importance of considering pheochromocytoma in patients with unexplained hyperlactemia during surgery.
- Anesthesiologists and surgeons should be aware of hyperlactemia as a diagnostic clue for pheochromocytoma.
- Prompt recognition and management of pheochromocytoma are crucial to prevent perioperative complications.
