Undiagnosed Pheochromocytoma Simulating Malignant Hyperthermia.
Nisha S Ramani1, Robert Stoppacher, Ajaykumar C Morani
1From the *SUNY Upstate Medical University, Syracuse, NY; and †The University of Texas MD Anderson Cancer Center, Houston, TX.
Summary
Pheochromocytoma, a rare tumor, can mimic malignant hyperthermia, leading to fatal outcomes if undiagnosed. Autopsy revealed a catecholamine-producing tumor as the cause of death, highlighting the need for vigilance.
Area of Science:
- Endocrinology
- Pathology
- Anesthesiology
Background:
- Pheochromocytomas are rare neuroendocrine tumors producing catecholamines.
- Early diagnosis is crucial as they are surgically curable but potentially lethal.
- This case highlights a patient misdiagnosed with malignant hyperthermia before autopsy confirmed pheochromocytoma.
Observation:
- A 53-year-old man developed severe hypertension, followed by a precipitous drop in blood pressure post-surgery.
- He exhibited high fever (42.2°C), rapid breathing, and ultimately died despite stabilization attempts.
- Autopsy revealed a large (10 cm) adrenal pheochromocytoma with high catecholamine levels (metanephrines/normetanephrine).
Findings:
- The patient's presentation mimicked malignant hyperthermia.
- The adrenal tumor was confirmed as the cause of death, complicated by general anesthesia.
- Elevated urinary catecholamine metabolites confirmed active pheochromocytoma.
Implications:
- Pheochromocytoma should be considered in the differential diagnosis of patients presenting with symptoms suggestive of malignant hyperthermia.
- Awareness among pathologists is essential when reviewing cases with a prior malignant hyperthermia diagnosis.
- Appropriate management of pheochromocytoma is critical to prevent fatal complications, especially during surgery.
Related Concept Videos
01:25Increased Body Temperature
7.6K
A body temperature above 38°C (100.4 °F) is known as fever or pyrexia, and a person with fever is termed 'febrile.' Typically, the hypothalamus, a part of the brain that acts as the body's thermostat, regulates body temperature through a thermoregulatory setpoint. It receives signals from cold and warm thermal receptors throughout the body and adjusts the body's temperature accordingly. Fever occurs when this hypothalamic setpoint is altered, usually in...
7.6K
01:25Types of Fever
1.3K
Fever can be triggered by several factors, including infections, nervous system disorders, certain cancers, blood diseases like leukemia, embolism, thrombosis, heatstroke, dehydration, surgical trauma, crushing injuries, and allergic reactions.
Here are the different types of fever:
Here are the different types of fever:
1.3K
01:19Homeostatic Imbalances in Body Temperature
4.3K
Hyperthermia occurs when the body's temperature becomes unusually high, often due to heat exposure, intense physical activity, or certain illnesses. This condition can create a dangerous cycle where elevated body temperature increases the metabolic rate, generating more heat and potentially leading to organ failure and brain damage. A severe form of hyperthermia, called heat stroke, can raise body temperature to life-threatening levels. Fever, on the other hand, is a controlled form of...
4.3K
01:15Hypoglycemia and Glucagon
1.1K
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
1.1K
01:27Adrenal Gland Disorders
3.6K
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
3.6K
01:30Toxidromes: Clinical Features
47
Toxidromes are specific patterns of symptoms resulting from toxic substance exposure. They help in the identification and treatment of poisoning. The symptoms of each toxidrome group indicate poisoning by a certain class of chemicals or drugs.1. Sympathomimetic: Stimulates the sympathetic nervous system. Symptoms include agitation, increased heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, and pupil size. Drugs like cocaine and amphetamines, along with tremors and...
47