Case reports, AANA Journal, April 1988

A case study is presented of a 34-year-old female who was diagnosed with a markedly hydronephrotic right kidney. The patient underwent a cystoscopy and a right nephrectomy during which a pheochromocytoma was suspected and subsequently confirmed by postoperative histologic examination. No laboratory analysis for urinary metanephrines or vanillylmandelic acid was carried out. Major problems associated with anesthesia during the perioperative period included uncontrolled hypertension, acute hypotension after ligation of venous return from the tumor and acute dysrhythmias. Since the pheochromocytoma was unsuspected preoperatively, the patient had no adrenergic blockade with concomitant volume loading. Consequently, she experienced wide fluctuations in blood pressure, heart rate and ventricular arrhythmias. Following venous ligation of the tumor, the patient experienced marked hypotension that readily responded to vasopressors and bolus IV fluid therapy. The patient experienced no medical problems postoperatively, even though she did require intravenous fluid volume with colloid and packed cells. Pheochromocytoma is a chromaffin tissue catecholamine-producing tumor. Although usually found in the adrenal medulla it may arise anywhere along the sympathetic ganglia. The clinical features and the surgical and anesthetic management have been well described since Dr. Charles Mayo performed the first resection of such a tumor in 1926. The author will present a case of a previously undiagnosed pheochromocytoma found in a patient undergoing surgery for a hydronephrous kidney.