HEMORRHAGIC PHEOCHROMOCYTOMA AND SEVERE CAROTID STENOSIS: A MULTIDISCIPLINARY APPROACH TO SURGICAL PRIORITIZATION

Area of Science:

• Endocrinology
• Surgical Oncology
• Vascular Surgery

Background:

• Pheochromocytomas are rare catecholamine-secreting tumors with diverse presentations.
• Spontaneous adrenal hemorrhage is an uncommon complication, complicating diagnosis, particularly in patients with comorbidities.

Purpose of the Study:

• To present a case of hemorrhagic pheochromocytoma with concurrent severe carotid artery stenosis.
• To discuss the management strategy for complex cases involving simultaneous adrenal and vascular pathology.

Main Methods:

• A 68-year-old male with hypertensive crises and syncope presented with abdominal pain.
• Imaging revealed a retroperitoneal hematoma from the right adrenal gland and 75% right internal carotid artery stenosis.
• The patient underwent successful right adrenalectomy after alpha-blockade, followed by carotid artery stenting.

Main Results:

• Histopathology confirmed pheochromocytoma with hemorrhagic and degenerative features.
• The multidisciplinary team recommended adrenalectomy prior to carotid intervention.
• The patient experienced a successful surgical outcome with both interventions.

Conclusions:

• Hemorrhagic pheochromocytoma can mimic acute abdominal or vascular emergencies.
• Individualized surgical sequencing is crucial in complex cases with comorbidities.
• Early tumor resection followed by vascular intervention can mitigate perioperative risks in patients with hemorrhagic pheochromocytoma and vascular disease.