CASE OF RETROPERITONEAL MASS WITH NEGATIVE BIOMEDICAL MARKER FOR PHEOCHROMOCYTOMA WITH ANTICIPATED DIFFICULT AIRWAY

Abstract

Pheochromocytomas are catecholamine secreting tumours that arise from chromaffin cells of the sympathoadrenal system. They account for fewer than 0.1% of all cases of hypertension in adults but have lethal potential and are one of the few truly curable forms of hypertension. The symptoms with the greatest “pooled sensitivity” are hypertension, headache, palpitation, and diaphoresis. The diagnosis is based on these symptoms and high levels of plasma-free normetanephrine and/or metanephrine. This report is of the successful anaesthetic management of a 40-year-old female, a known case of hypertension for 10 years, with only low back ache, and vomiting as her presenting complaints, posted for excision of a retro-peritoneal mass, whose intraoperative tumour manipulation led to a hypertensive crisis, showing its true colours! The histopathological report of resected specimen, obtained post-operatively, came to be consistent with pheochromocytoma. A high level of clinical suspicion of pheochromocytoma in such cases will turn out to be the saviour of the day, by prompting us to meticulously evaluate, appropriately optimise and adequately prepare for any intra-operative events in an otherwise “simple case abdominal mass excision!”