[Hypertension emergency during surgery of renal carcinoma associated with non-diagnosed pheochromocytoma].
OBJECTIVE
To present an uncommon association of renal carcinoma with an undiagnosed ipsilateral pheochromocytoma that caused severe cardiovascular disorders during surgical treatment of the renal carcinoma, and emphasize the need for careful assessment of these adrenal nodules before resection although they may appear to be clinically irrelevant.


METHODS
A 61-year-old male with mild arterial hypertension controlled with drug therapy for 40 years was diagnosed as having a right renal hypernephroma and a probable adrenal adenoma by IVP, abdominal ultrasound, CT, bone scintiscan and renal arteriography. Preoperative values were within the normal limits. The patient developed severe hypertension intraoperatively, which was controlled by administration of lidocaine, nitroglycerine, sodium nitroprusside and labetalol. Surgery was interrupted and completed when the patient was stable.


RESULTS
The pathological analysis showed clear cell renal adenocarcinoma and pheochromocytoma. Postoperative evaluation showed dopamine, adrenaline, noradrenaline and vanilmandelic acid were normal. A 131 MIBG scan was normal.


CONCLUSIONS
Although an adrenal mass may appear to be clinically irrelevant, a careful study should be performed to discard a functioning tumor and to avoid the serious complications that might arise during surgery.
Egea Camacho
J
J
Servicio de Urología Hospital Clínico Universitario C/Ramón y Cajal s/n 47005 Valladolid, España.
Fernández del Busto
E
E
González de Zárate
J
J
Trueba Arguiñarena
F J
FJ
Sanz Lucas
F J
FJ
Pascual Samaniego
M
M
D000310:Adrenal Gland Neoplasms / Q000150:complications*; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D004630:Emergencies; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications*