Perioperative management of a large, late presenting phaeochromocytoma

BMJ Case Rep. 2017 Jan 18:2017:bcr2016218126. doi: 10.1136/bcr-2016-218126.

Abstract

A 77-year-old man presenting to the emergency department with an acute coronary syndrome was later found to have a phaeochromocytoma. The lateness of this presentation was likely due to the protective α blocking effects of long-term terazosin therapy for his prostatism. α blockers such as terazosin are a well-recognised medical therapy in the perioperative optimisation of phaeochromocytoma because they treat the adrenergic effects of catecholamine release from the tumour such as hypertension. This patient was diagnosed with an ST elevation myocardial infarction (STEMI). A cardiac angiogram showed no evidence of vessel occlusion. A right adrenal mass of 9×8×9 cm was incidentally found and confirmed as a phaeochromocytoma with raised plasma metanephrines and normetanephrines. Following preoperative optimisation and multidisciplinary team involvement, an open right adrenalectomy was performed successfully some months later.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Gland Neoplasms / complications
  • Adrenal Gland Neoplasms / diagnostic imaging
  • Adrenal Gland Neoplasms / therapy*
  • Adrenalectomy*
  • Adrenergic alpha-Antagonists / therapeutic use*
  • Aged
  • Coronary Angiography
  • Electrocardiography
  • Humans
  • Male
  • Perioperative Care*
  • Phenoxybenzamine / therapeutic use*
  • Pheochromocytoma / complications
  • Pheochromocytoma / diagnostic imaging
  • Pheochromocytoma / therapy*
  • ST Elevation Myocardial Infarction / diagnosis*
  • ST Elevation Myocardial Infarction / etiology
  • Tomography, X-Ray Computed

Substances

  • Adrenergic alpha-Antagonists
  • Phenoxybenzamine