Undiagnosed phaeochromocytoma in the perioperative period. Case reports.
Phaeochromocytomas appear as frequently as one in 1000-2000 patients. Release of catecholamines may be triggered by events in the perioperative period. Patients whose phaeochromocytomas are diagnosed in this period, have a mortality of about 80%. Three patients with perioperative debut of symptoms of a phaeochromocytoma are presented. A possible drug-induced release of catecholamines from the tumour is suggested for two of the patients. The first symptoms of a phaeochromocytoma may be arrhythmias and shock, which favours the use of adrenergic blockade prior to elective removal of phaeochromocytomas. Therapeutic approaches to the treatment of catecholamine-induced heart failure may be potassium and magnesium supplements and possibly drugs reducing circulating angiotensin II activities. Caution is advised in the use of digitalis.
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002395:Catecholamines / Q000378:metabolism; D005260:Female; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007340:Insulinoma / Q000175:diagnosis; D007431:Intraoperative Complications / Q000209:etiology; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D011183:Postoperative Complications / Q000209:etiology*; D012770:Shock, Cardiogenic / Q000209:etiology; D014433:Tympanoplasty / Q000009:adverse effects
D002395:Catecholamines