A Heady Challenge

Successful removal of Pheochromocytoma Tumour

THE CASE

A 62-year old, non-diabetic lady with fluctuating blood pressure, visited Nanavati Super Speciality Hospital, with complaints of palpitation, sweating and headache for the past two months. On investigation, her cardiac workup was negative. Sonography abdomen and pelvis, showed mass in left adrenal gland. CT scan showed 6.5 cm x 5 cm mass arising from the adrenal gland. Left kidney was not involved. There was suspicion of Pheochromocytoma from the CT scan findings. Her blood pressure readings were high and fluctuating (180/100 mm hg). Urinary VMA showed high value (40) as was her plasma metanephrine levels. Considering clinical examination and investigations, a surgery was planned and the patient was put on alpha blockers to control fluctuating blood pressure for ten days.

THE PROCEDURE

The surgery took the approach from the left renal incision (cutting through the 11th rib). During induction, the blood pressure was within normal limits. During surgery, though, when the Tumour was approached for dissection, blood pressure started fluctuating (from 180/100 to 300/170 mm hg). Dissection around the Tumour was very carefully done to avoid the Tumour to the best possible extent. As the Tumour was completely removed, blood pressure levels started falling down and were well-managed by the Anaesthetist and Cardiologist.

THE RESULT

Post surgery the patient was kept in the ICU for a day for proper monitoring. Her post-operative period was uneventful and her blood pressure was well maintained. Palpitation, sweating and headache were also not observed during this period. Histopathology report revealed Benign Pheochromocytoma. The patient was safely discharged on seventh post-operative day.

Dr. Sanjay Dudhat
Surgical Oncologist
Oncology
Nanavati Super Speciality
Hospital, Mumbai