Anesthesia management of a ganglioneuroma with seizures presenting as pheochromocytoma.
Ganglioneuromas (GN) are neural crest cell-derived tumors which may coexist with pheochromocytomas, secrete various neuropeptides or the symptoms may mimic that of a pheochromocytoma, producing hypertension or a hypotensive crisis during anesthesia for these tumors. We report here the case of a 7-year-old female child with an adrenal tumor suspected to be a pheochromocytoma, later confirmed by histology as a GN. This child presented with episodic headache, anxiety, palpitations and 3D helical (spiral) computed tomography of the abdomen revealed an adrenal tumor. In addition, the child was diagnosed to have a seizure disorder. She was managed as a pheochromocytoma. Although the child's preoperative catecholamine levels were normal, tumor manipulation caused a hypertensive crisis. We discuss the clinical characteristics of this unusual case, anesthesia management, and the postoperative course.
Batra
Yatindra Kumar
YK
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. ykbatra@glide.net.in
Rajeev
Subramanyam
S
Rao
Katragadda Ln
KL
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000758:Anesthesia / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001007:Anxiety / Q000209:etiology; D001794:Blood Pressure / Q000187:drug effects; D002496:Central Venous Pressure / Q000187:drug effects; D002648:Child; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005729:Ganglioneuroma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006261:Headache / Q000209:etiology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010673:Pheochromocytoma / Q000175:diagnosis*; D011860:Radiography, Abdominal / Q000379:methods; D035583:Rare Diseases; D036542:Tomography, Spiral Computed / Q000379:methods
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000959:Antihypertensive Agents; D003473:Neuromuscular Nondepolarizing Agents