Pheochromocytoma

• Published in: Anesthesiology pp. 183 - 189
• Main Authors: Gayle, Julie A., Rubin, Ryan, Kaye, Alan D.
• Format: Book Chapter
• Language: English
• Published: Switzerland Springer International Publishing AG 2017; Springer International Publishing
• Subjects: Adrenal gland; Anaesthetics; Anesthesia; Hypertensive crisis; Intensive care medicine; Multiple endocrine neoplasia type 2; Pain & pain management; Phenoxybenzamine; Pheochromocytoma; Pregnancy; Surgery
• ISBN: 9783319501390; 3319501399
• DOI: 10.1007/978-3-319-50141-3_26

Anesthetic management of patients with pheochromocytoma is challenging and complicated for the anesthesiologist. Pheochromocytomas are rare, potentially lethal neuroendocrine tumors that have a highly variable clinical presentation. Classic symptoms include headaches, sweating, and palpitations combined with paroxysmal or sustained hypertension. Prompt recognition and diagnosis of symptoms followed by proper preoperative pharmacologic management has improved perioperative outcome. An understanding of the pathophysiology of excessive catecholamine release and the consequences of extreme hemodynamic fluctuations allow for an understanding of the role of pharmacologic preparation for surgery, intraoperative management, and postoperative sequelae. Preoperative preparation for a patient with pheochromocytoma includes the administration of alpha-adrenergic blocking agents to reduce the risk of hypertensive crisis during induction of anesthesia and tumor manipulation. Invasive intraoperative monitoring, as well as preparedness and recognition of hemodynamic perturbations, are imperative to assure appropriate prompt treatment of hypertensive and/or hypotensive episodes. Postoperatively, periods of hypotension or hypertension and hypoglycemia are common and, therefore, require proper management. Finally, two special populations with pheochromocytoma are reviewed. Perioperative management of the parturient with pheochromocytoma and patients with undiagnosed pheochromocytoma undergoing anesthesia and surgery are at high risk for unanticipated, life-threatening hypertensive crisis.