Intraoperative hypertensive crisis secondary to an undiagnosed pheochromocytoma during orthognathic surgery: a case report.
Increased blood pressure (BP) during orthognathic surgery may result in excessive blood loss, poor surgical field visualization, and longer surgical time and require blood transfusion. When uncontrollable high BP is encountered in an otherwise healthy patient during orthognathic surgery, the diagnosis of pheochromocytoma should be considered. Pheochromocytomas are rare neuroendocrine tumors of the chromaffin cells of the adrenal medulla or extra-adrenal paraganglia (sympathetic ganglia) that secrete catecholamine. They are present in approximately 0.05 to 0.2% of hypertensive patients. Patients can present with hypertension, tachycardia, headaches, and diaphoresis. The clinical presentation may vary and a wide spectrum of nonspecific symptoms may be encountered. The elevated BP can be intermittent (40%) or permanent (60%). About 10% of pheochromocytomas are hereditary and they can be a feature of multiple endocrine neoplasia type 2. This report describes the case of a 29-year-old patient with a large pheochromocytoma of the right adrenal gland undiagnosed before orthognathic surgery.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital de l'Enfant-Jésus, Québec, Québec, Canada. Electronic address: carl.bouchard@fmd.ulaval.ca.
Carl
C
Bouchard
Assistant Professor, Department of Anesthesiology; Department of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital de l'Enfant-Jésus, Québec, Québec, Canada.
Gilles
G
Chiniara
Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital de l'Enfant-Jésus, Québec, Québec, Canada.
Annie-Claude
AC
Valcourt
D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007431:Intraoperative Complications; D008312:Malocclusion, Angle Class II / Q000601:surgery; D056948:Orthognathic Surgical Procedures; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications
D000959:Antihypertensive Agents