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Pheochromocytoma without specific symptoms.

T Naruse, A Koike, T Kanemitsu

    The Japanese Journal of Surgery
    |May 1, 1984
    PubMed
    Summary
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    Even asymptomatic pheochromocytoma cases require preoperative management. Incidental adrenal tumors suspected of pheochromocytoma need careful catecholamine blockade before surgery to prevent intraoperative complications.

    Area of Science:

    • Endocrinology
    • Oncology
    • Surgical Oncology

    Background:

    • Pheochromocytoma is a rare neuroendocrine tumor arising from chromaffin cells, typically in the adrenal medulla.
    • Symptoms often include hypertension, palpitations, and headaches due to catecholamine excess, but presentation can be variable.

    Observation:

    • A 72-year-old woman presented with mild abdominal pain, leading to the incidental discovery of a large retroperitoneal tumor.
    • Preoperative tests showed only mild elevations in urinary catecholamines, with no distinctive clinical signs or diagnostic changes in serum catecholamines during provocation tests.
    • Despite the lack of clear indicators, the tumor was suspected to be pheochromocytoma based on its origin and mild biochemical abnormalities.

    Findings:

    • Surgery was performed without preoperative catecholamine blockade due to the absence of typical pheochromocytoma symptoms and diagnostic test results.

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  • Significant fluctuations in blood pressure and pulse rate occurred during the surgical procedure, highlighting the tumor's potential for catecholamine release.
  • The intraoperative events confirmed the pheochromocytoma's capacity to cause hemodynamic instability despite its initially non-functioning presentation.

    • Implications:

    • Incidental pheochromocytomas, even those lacking characteristic symptoms or clear biochemical evidence, must be treated as potentially functional.
    • Preoperative catecholamine blockade is crucial for managing patients with suspected pheochromocytoma, regardless of preoperative findings, to mitigate surgical risks.
    • This case underscores the importance of vigilance in managing incidentally discovered adrenal masses that could represent pheochromocytoma.