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LETTERS TO THE EDITOR

Laparoscopic Resection of Unsuspected Pheochromocytoma

Department of Anesthesia Shimada Municipal Hospital Shimada, Shizuoka 427, Japan

I agree with Joris et al.’s (1) recommendation that laparoscopic resection of pheochromocytoma must be performed by an experienced surgeon and anesthesiologist. The following case indicates that precise diagnosis and cautious preoperative preparation are also prerequisites for this procedure.

A 55-yr-old patient was scheduled for laparoscopic resection of an incidentally detected right adrenal tumor, which was diagnosed as nonfunctioning as a result of the lack of apparent symptoms and the negative results of urinary qualitative detection of vanillylmandelic acid and I¹³¹-metaiodobenzylguanidine scintigraphy. Anesthesia was induced uneventfully, but pneumoperitoneum and retroperitoneal dissection abruptly increased systolic blood pressure to >250 mm Hg. Aggressive use of nicardipine maintained the systolic blood pressure at <200 mm Hg with difficulty. Histological investigation and analyses of plasma epinephrine and norepinephrine levels during the surgery (2.83 and 15.07 ng/mL, respectively) revealed that the tumor was pheochromocytoma.

Anesthesia and surgery for unsuspected pheochromocytoma are extremely dangerous (2). An increased number of adrenal masses were recently detected incidentally by imaging procedures (3), and 4%–11% of these masses were identified as pheochromocytoma, which can be asymptomatic (4,5). Precise preoperative diagnosis and cautious preoperative preparation are essential for safe anesthetic management of such cases (6).

References

1. Joris JL, Hamoir EE, Hartstein GM, et al. Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesth Analg 1999;88:16–21.[Abstract/Free Full Text]
2. Ambesh SP. Occult pheochromocytoma in association with hyperthyroidism presenting under general anesthesia. Anesth Analg 1993;77:1074–6.[Free Full Text]
3. Mantero F, Masini AM, Opocher G, et al. Adrenal incidentaloma: an overview of hormonal data from the National Italian Study Group. Horm Res 1997;47:284–9.[Web of Science][Medline]
4. Gagner M, Breton G, Pharand D, Pomp A. Is laparoscopic adrenalectomy indicated for pheochromocytoma? Surgery 1996;120:1076–80.[Web of Science][Medline]
5. Linos DA, Stylopoulos N, Raptis SA. Adrenaloma: a call for more aggressive management. World J Surg 1996;20:788–93.[Medline]
6. Russell WJ, Metcalfe IR, Tonkin AL, Frewin DB. The preoperative management of phaeochromocytoma. Intensive Care 1998;26:196–200.

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