title: Anesthesia management of a ganglioneuroma with seizures presenting as pheochromocytoma.
abstract: 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.
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. ykbatra@glide.net.in
authors.forename: Yatindra Kumar
authors.initials: YK
authors.lastname: Batra
authors.forename: Subramanyam
authors.initials: S
authors.lastname: Rajeev
authors.forename: Katragadda Ln
authors.initials: KL
authors.lastname: Rao
mesh_terms: 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
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000959:Antihypertensive Agents; D003473:Neuromuscular Nondepolarizing Agents