Adrenal tumour secreting vasoactive intestinal peptide and noradrenaline

A patient with a ganglioneuroblastoma secreting both noradrenaline and vasoactive intestinal peptide is described. Their vasoactive effects are antagonistic and pre-operatively the patient was normotensive. Manipulation of the tumour provoked hypertension and after excision marked hypotension occurred which responded to the administration of metaraminol and blood. This case emphasises the need for thorough investigation of patients with amine or peptide-secreting tumours which have atypical features.