Laparoscopic right adrenalectomy in a female with malignant hypertension secondary to pheochromocytoma: a case report

B. Vijay Kumar; G. Vamshi Nandan Rao; M. Veena

doi:10.18203/2349-3933.ijam20261881

Authors

B. Vijay Kumar Department of General Medicine, Yashoda Hospitals, Secunderabad, Telangana, India
G. Vamshi Nandan Rao Department of General Medicine, Yashoda Hospitals, Secunderabad, Telangana, India
M. Veena Department of General Medicine, Yashoda Hospitals, Secunderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20261881

Keywords:

Laparoscopic adrenalectomy, Pheochromocytoma, Secondary hypertension, Adrenal tumours

Abstract

Pheochromocytomas are uncommon adrenal tumors that can present considerable clinical difficulties because of their ability for catecholamine release and hypertensive crises. We report a case of a pheochromocytoma treated effectively with laparoscopic adrenalectomy. A 36-year-old woman was presented with secondary hypertension. Preoperative IV fluids, IV PPI’s, blockade was initiated with antihypertensive drugs to optimize hemodynamic control. The patient had a laparoscopic adrenalectomy. Histopathological analysis confirmed the diagnosis of pheochromocytoma with presence of Zellballan pattern and pheochromocytoma of the adrenal gland scaled score (PASS). Complications were minimal, with low hemoglobin, and 1 unit of PRBC was transfused. Post operatively, blood pressure and electrolytes levels were normalized. Laparoscopic adrenalectomy shown to be a reliable and efficient method for treating pheochromocytoma, resulting in improved blood pressure regulation and quality of life for the patient. This case highlights the significance of a multidisciplinary strategy, encompassing preoperative medical optimization and diligent postoperative observation, in the management of pheochromocytomas, and contributes to the increasing evidence favouring laparoscopic adrenalectomy for these adrenal tumors.

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Author Biographies

B. Vijay Kumar, Department of General Medicine, Yashoda Hospitals, Secunderabad, Telangana, India

Senior Consultant Physician and Head, Department of General Medicine

M. Veena, Department of General Medicine, Yashoda Hospitals, Secunderabad, Telangana, India

Associate Consultant Physician, Department of General Medicine

References

Yurt A, Arda MN, Vardar E. Metastatic pheochromocytoma of the thoracic spinal extradural space. Case report and review of the literature. Kobe J Med Sci. 2005;51(4):49-53.

Mihai I, Boicean A, Teodoru CA, Grigore N, Iancu GM, Dura H, et al. Laparoscopic Adrenalectomy: Tailoring Approaches for the Optimal Resection of Adrenal Tumors. Diagnostics 2023;13(21):3351. DOI: https://doi.org/10.3390/diagnostics13213351

Pacak K, Eisenhofer G, Ilias I. Diagnosis of pheochromocytoma with special emphasis on MEN2 syndrome. Horm Athens Greece. 2009;8:111-6. DOI: https://doi.org/10.14310/horm.2002.1227

Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Do Cao C, et al. Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surg Endosc. 2017;31(7):2743-51. DOI: https://doi.org/10.1007/s00464-016-4830-0

Prejbisz A, Lenders JWM, Eisenhofer G, Januszewicz A. Cardiovascular manifestations of phaeochromocytoma. J Hypertens. 2011;29:2049-60. DOI: https://doi.org/10.1097/HJH.0b013e32834a4ce9

Liu S, Song A, Zhou X, Kong X, Li WA, Wang Y, et al. Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy: Literature review with one case report. Medicine (Baltimore). 2017;96(44):e8535. DOI: https://doi.org/10.1097/MD.0000000000008535

Guerrero MA, Schreinemakers JM, Vriens MR, Suh I, Hwang J, Shen WT, et al. Clinical spectrum of pheochromocytoma. J Am Coll Surg 2009;209(6):727-32. DOI: https://doi.org/10.1016/j.jamcollsurg.2009.09.022

Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327(14):1033. DOI: https://doi.org/10.1056/NEJM199210013271417

Miccoli P, Raffaelli M, Berti P, Materazzi G, Massi M, Bernini G. Adrenal surgery before and after the introduction of laparoscopic adrenalectomy. Br J Surg. 2002;89(6):779-82. DOI: https://doi.org/10.1046/j.1365-2168.2002.02110.x

Eisenhofer G, Siegert G, Kotzerke J, Bornstein SR, Pacak K. Current progress and future challenges in the biochemical diagnosis and treatment of pheochromocytomas and paragangliomas. Horm Metab Res. 2008;40:329-37. DOI: https://doi.org/10.1055/s-2008-1073156

Garg MK, Kharb S, Brar KS, Gundgurthi A, Mittal R. Medical management of pheochromocytoma: Role of the endocrinologist. Indian J Endocrinol Metab. 2011;15:S329-36. DOI: https://doi.org/10.4103/2230-8210.86976

Young WF. Paragangliomas: Clinical Overview. Ann N Y Acad Sci. 2006;1073:21-9. DOI: https://doi.org/10.1196/annals.1353.002

Munakomi S, Rajbanshi S, Adhikary PS. Case Report: A giant but silent adrenal pheochromocytoma-a rare entity. F1000Res. 2016;5:290. DOI: https://doi.org/10.12688/f1000research.8168.1

Strong VE, Kennedy T, Al-Ahmadie H, Tang L, Coleman J, Fong Y, et al. Prognostic indicators of malignancy in adrenal pheochromocytomas: Clinical, histopathologic and cell cycle/apoptosis gene expression analysis. Surgery. 2008;143:759-68. DOI: https://doi.org/10.1016/j.surg.2008.02.007