title: Refractory hypotension during spinal anesthesia for Cesarean delivery due to undiagnosed pheochromocytoma.
abstract: Profound hypotension and resistance to conventional vasopressor therapy following administration of spinal anesthesia for Cesarean delivery occurred in a multiparous parturient. Postpartum evaluation for secondary hypertension showed a diagnosis of pheochromocytoma. Pheochromocytoma was mistaken for preeclampsia with significant vasopressor requirement to treat hypotension from spinal anesthesia. If pheochromocytoma is diagnosed during pregnancy and Cesarean delivery is required, spinal anesthesia may not be the optimal choice of anesthesia.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. Electronic address: johnson.rebecca1@mayo.edu.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Johnson
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Arendt
authors.affiliation: Department of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Rose
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Michelle A O
authors.initials: MA
authors.lastname: Kinney
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002585:Cesarean Section; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology*; D007431:Intraoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis; D011225:Pre-Eclampsia / Q000175:diagnosis; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis*; D017211:Treatment Failure
chemical_list: D000316:Adrenergic alpha-Agonists
keywords: Anesthesia: obstetrical; Cesarean section; Hypotension; Pheochromocytoma; Pregnancy-induced hypertension; Spinal anesthesia