A Heady Challenge
Successful removal of Pheochromocytoma Tumour
A 62-year old, non-diabetic lady with fluctuating blood pressure, visited
Nanavati Super Speciality Hospital, with complaints of palpitation,
sweating and headache for the past two months. On investigation,
her cardiac workup was negative. Sonography abdomen and pelvis,
showed mass in left adrenal gland. CT scan showed 6.5 cm x 5 cm mass
arising from the adrenal gland. Left kidney was not involved. There
was suspicion of Pheochromocytoma from the CT scan findings. Her
blood pressure readings were high and fluctuating (180/100 mm hg).
Urinary VMA showed high value (40) as was her plasma metanephrine
levels. Considering clinical examination and investigations, a surgery
was planned and the patient was put on alpha blockers to control
fluctuating blood pressure for ten days.
The surgery took the approach from the left renal incision (cutting
through the 11th rib). During induction, the blood pressure was
within normal limits. During surgery, though, when the Tumour was
approached for dissection, blood pressure started fluctuating (from
180/100 to 300/170 mm hg). Dissection around the Tumour was very
carefully done to avoid the Tumour to the best possible extent. As the
Tumour was completely removed, blood pressure levels started falling
down and were well-managed by the Anaesthetist and Cardiologist.
Post surgery the patient was kept in the ICU for a day for proper
monitoring. Her post-operative period was uneventful and her blood
pressure was well maintained. Palpitation, sweating and headache
were also not observed during this period. Histopathology report
revealed Benign Pheochromocytoma. The patient was safely discharged
on seventh post-operative day.