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A 36-year-old woman was admitted under gynaecology services with a case of Bartholin abscess. She had a past history of type 2 diabetes and hypertension. During admission she was investigated for uncontrolled blood pressure and diagnosed as having a paraganglioma. Her blood pressure was controlled on α and β blockers and she underwent operation without complications.
Phaeochromocytomas and paragangliomas are rare neuroendocrine tumours with highly variable clinical presentation, but they most commonly present as spells of headaches, sweating, palpitations and hypertension. Patients with phaeochromocytoma may develop complicated and potentially lethal cardiovascular and other complications, especially in the setting of diagnostic or interventional procedures (eg, upon induction of anaesthesia or during surgery). The serious and potentially lethal nature of such complications is due to the potent effect of paroxysmal release of catecholamines. Because this warrants prompt diagnosis and treatment, the doctor should be aware of the clinical manifestations and complications of catecholamine excess and be able to provide proper preoperative management to minimise catecholamine-related preoperative, intraoperative and postoperative adverse events. The following clinical scenario and discussion aim to enhance the knowledge of doctors regarding the behaviour of phaeochromocytoma, and to outline current approaches to comprehensive preoperative management of patients with this tumour.
The patient was admitted under gynaecology service for management of a Bartholin abscess. She was referred for medical consultation for uncontrolled blood pressure, which ranged from 180 to 240 mm Hg systolic and 110 to 140 mm Hg diastolic. On direct questioning she admitted to having had episodic headaches, palpitations, sweating and panic attacks. She had no history of weight loss, shortness of breath, menstrual disorders or visual problems.
She has no family history of hypertension or diabetes. She is a married housewife, non-smoker and non-alcoholic with no particular concerns. She had no significant past medical or surgical history. …
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