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Perioperative management of a large, late presenting phaeochromocytoma
  1. Duncan Macrosson,
  2. Andrew Love
  1. North Shore Hospital, Auckland, New Zealand
  1. Correspondence to Dr Duncan Macrosson, duncanmacrosson{at}


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.

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  • Contributors DM was responsible for consent, writing of case report, discussion and literature review. AL reviewed the article as a whole.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.