Another Undiagnosed Pheochromocytoma Causes Hypertensive Crisis in the Operating Room—What about a Rapid Blood Metanephrine Test?

Undiagnosed pheochromocytoma is a cause of hypertension intraoperatively. Hypertension from pheochromocytoma catecholamine secretion is potentially fatal and requires immediate treatment with cardiac afterload reduction and preload augmentation for end-organ protection. Diagnosis and management in the acute period can be complex in the context of co-existing disease, other possible causes of hypertension, and the anesthetized patient who is unable to provide historical clues. This case report highlights the plausibility that pheochromocytomas may be more likely to present subclinically in elderly patients with severe vascular disease, so we suggest the potential utility of studying whether reduced vascular responsiveness is protective in any way to catecholamine load. Above all, as an increasing number of case reports of pheochromocytoma discovery intra-operatively emerge, many with catastrophic outcomes, the development value and feasibility of a rapid, on-site blood metanephrine test should be considered. Existing diagnostic methods of pheochromocytoma are relatively time-consuming and not useful in the acute situation.