[A case of pheochromocytoma incorrectly diagnosed before and during surgery]

In a patient with an adrenal tumor, although norepinephrine levels in the blood and urine were abnormally high, findings in CT and 131 I-MIBG scintigraphy denied pheochromocytoma. The preoperative diagnosis was metastatic adrenal tumor. The surgical manipulation of the tumor increased the blood pressure from 110/60 to 210/110 mmHg. However, intraoperative microscopic examination in frozen section excluded again possibility of pheochromocytoma. Later, findings in the permanent specimen confirmed that the tumor was pheochromocytoma. The problem of this case was that each specialist made judgment only on the subject of his own interest without considering of the patient's status as a whole. Anesthesiologist should have the ability to make preoperative assessment of a patient by using all available information with his unbiased mind.