Pheochromocytoma crisis with severe cyclic blood pressure fluctuations in a cardiac pheochromocytoma patient successfully resuscitated by extracorporeal membrane oxygenation: a case report.
Cardiac pheochromocytoma is relatively rare. Few reports describe the intraoperative and postoperative progression of patients experiencing a life-threatening pheochromocytoma crisis treated with extracorporeal membrane oxygenation (ECMO).A 35-year-old man was referred to our facility for paroxysmal hypertension with a 10-year history of sweating, headaches, cardiac palpitations, and postexercise dyspnea. The patient initially underwent urine catecholamine measurement and an isotope scan, somatostatin receptor scintigraphy, and 18F-fluorodeoxyglucose positron emission tomography/computer tomography (CT), which indicated a multiple, cardiac pheochromocytoma. Echocardiography, cardiac magnetic resonance imaging (MRI), CT reconstruction, and a coronary CT angiography revealed several lesions at the aortic root and along the cardiac vasculature.Multifocal cardiac pheochromocytoma was diagnosed and pheochromocytoma crisis with severe cyclic blood pressure fluctuation occurred during surgery.Surgical resection of multiple pheochromocytomas in the right medial carotid sheath, mediastinum between the main and pulmonary arteries, and between the abdominal aorta and inferior vena artery was performed. To ensure cardiac perfusion and avoid severe circulatory fluctuation, the cardiac paraganglioma resection was prioritized. After resecting the cardiac pheochromocytoma, a severe pheochromocytoma crisis with rapid cyclic blood pressure fluctuation developed. ECMO and intraaortic balloon pump (IABP) were initiated to stabilize circulation and perfusion. Phenoxybenzamine, norepinephrine, epinephrine, and fluid resuscitation were administered to support cardiovascular function.The magnitude of blood pressure fluctuation steadily decreased with treatment. IABP was discontinued after 3 days, and ECMO was discontinued after 16 days. The patient was discharged 3 months postoperatively.This case indicates that mechanical life support with ECMO is a valuable option for pheochromocytoma-induced cardiac shock and should be considered as an effective therapeutic choice in patients with highly unstable hemodynamic function.
From the Department of Critical Care Medicine (XZ, DL, LS, YL, WD); Department of Cardiac Surgery (QM); Department of Nuclear Medicine (FL); Department of Radiology (ZJ); Department of Endocrinology (ZZ); and Department of Anesthesiology (AL, YH), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Xiang
X
Zhou
Dawei
D
Liu
Longxiang
L
Su
Yun
Y
Long
Wei
W
Du
Qi
Q
Miao
Fang
F
Li
Zhengyu
Z
Jin
Zhengpei
Z
Zeng
Ailun
A
Luo
Yuguang
Y
Huang
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000328:Adult; D001794:Blood Pressure; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D015199:Extracorporeal Membrane Oxygenation; D005440:Fluid Therapy; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000601:surgery