title: Intraoperative hypertensive crisis due to a catecholamine-secreting esthesioneuroblastoma.
abstract: BACKGROUND
  Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines.
  
  
  METHODS
  We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed an intraoperative hypertensive crisis.
  
  
  RESULTS
  A patient with a history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Workup revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade before the second stage. Serum catecholamine levels after this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in catecholamine synthesis, and achaete-scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons.
  
  
  CONCLUSIONS
  Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Vafi
authors.initials: V
authors.lastname: Salmasi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Adam
authors.initials: A
authors.lastname: Schiavi
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Zev A
authors.initials: ZA
authors.lastname: Binder
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jacob
authors.initials: J
authors.lastname: Ruzevick
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Orr
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Burger
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Ball
authors.affiliation: Division of Neuroradiology, Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Blitz
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Koch
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage; D001707:Biopsy, Needle; D002395:Catecholamines / Q000378:metabolism*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis* / Q000188:drug therapy; D007150:Immunohistochemistry; D007431:Intraoperative Complications / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology / Q000601:surgery*; D009669:Nose Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery*; D035583:Rare Diseases; D018570:Risk Assessment; D019292:Skull Base Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002395:Catecholamines
keywords: catecholamine; esthesioneuroblastoma; expanded endonasal endoscopic approach; hypertensive crisis; tyrosine hydroxylase