Attempted Removal of a Large Pheochromocytoma via a Robotic Approach

A pheochromocytoma is a rare tumor of neuroendocrine origin that secretes hormones like epinephrine, norepinephrine, and occasionally dopamine. The most notable symptom of the release of catecholamines is exceedingly high blood pressure. A 45-year-old male presented with a symptomatic pheochromocytoma of large size. He reported experiencing fatigue, orthopnea, dizziness, headache, and chest tightness with deep inspiration for several months. At the time of presentation, he was found to be in hypertensive emergency and was started on alpha-blockade for several days followed by a beta-blockade for a total of 28 days of anti-hypertensive treatment. During his admission, CT imaging showed his tumor to measure at least 14 cm in length, larger than most. After stabilization of the patient, an attempt was made to resect the tumor robotically, but the procedure was converted to an open left adrenalectomy owing to the size of the tumor and the number of tributaries. The patient tolerated the procedure well and, afterward, his blood pressure normalized. He recovered postoperatively with minimal hypotensive episodes and was started on physical therapy. This report reviews the details and management of this case.