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

Pheochromocytomas are rare catecholamine-secreting tumors that may present with nonspecific symptoms or life-threatening crises. Spontaneous adrenal hemorrhage is a rare complication that complicates diagnosis, especially in patients with comorbidities.

A 68-year-old male presented with severe abdominal pain, a history of hypertensive crises, and episodes of syncope. Imaging revealed a retroperitoneal hematoma originating from the right adrenal gland. Biochemical evaluation confirmed pheochromocytoma, and further imaging showed 75% stenosis of the right internal carotid artery. A multidisciplinary team recommended right adrenalectomy prior to carotid intervention. After alpha-blockade with phenoxybenzamine, the patient underwent successful adrenalectomy and hematoma evacuation. Histopathology confirmed pheochromocytoma with hemorrhagic and degenerative features. Carotid artery stenting was performed postoperatively.

Hemorrhagic pheochromocytoma may mimic other acute abdominal or vascular conditions, especially in patients on anticoagulation. Noradrenergic pheochromocytomas are linked to a higher risk of atherosclerosis. In such complex scenarios, surgical sequencing must be individualized.

In patients with hemorrhagic pheochromocytoma and significant vascular disease, early tumor resection followed by vascular intervention can reduce perioperative risks. A multidisciplinary approach is essential for optimal outcomes.