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Perioperative Management of a Giant Pheochromocytoma Resection: A Case Report with Literature Review
Xia Li1, Xingsheng Wang2*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
2Department of Anesthesiology, Zizhong County People's Hospital, Neijiang, Sichuan, 641200, China
Corresponding Author: Xingsheng Wang
Address: Department of Anesthesiology, Zizhong County People's Hospital, No. 92 Yingbin Road, Chonglong Town, Zizhong County, Neijiang, Sichuan, 641200, China.
Received date: 22 June 2025; Accepted date: 03 July 2025; Published date: 11 July 2025
Citation: Li X, Wang X. Perioperative Management of a Giant Pheochromocytoma Resection: A Case Report with Literature Review. Asp Biomed Clin Case Rep. 2025 Jul 11;8(2):122-28.
Copyright © 2025 Li X, Wang X. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Giant Pheochromocytoma, Perioperative Management, Hemodynamics, Anesthesiology, Multimodal Monitoring; Vasoplegia, Case report
Abstract
Background: Pheochromocytoma, a rare endocrine tumor, produces substantial quantities of catecholamines, leading to severe cardiovascular complications. Perioperative management for its surgical resection entails significant risks. This case report, detailing the anesthetic and perioperative management of a giant pheochromocytoma excision, underscores the complexity inherent in managing these tumors and emphasizes the critical importance of employing multiple monitoring modalities for dynamic assessment to guide timely therapeutic interventions.
Case Report: We report a case of a 31-year-old female patient who presented with abdominal pain and was found to have a large mass in the left retroperitoneal adrenal region. The diagnosis of pheochromocytoma was confirmed by plasma catecholamine assays and high-resolution computed tomography (HRCT). Following preoperative pharmacologic preparation with alpha-adrenergic blockade, surgical resection of the tumor was performed. Intraoperatively, the patient developed significant hemodynamic instability, notably persistent hypotension after tumor removal that was refractory to empirical management. Combined transesophageal echocardiography (TEE) and pulse index continuous cardiac output (PiCCO) monitoring were employed for comprehensive assessment of cardiac function and volume status. Real-time guidance from this multimodal monitoring facilitated dynamic adjustments to the therapeutic strategy, enabling goal-directed hemodynamic support. Ultimately, the patient experienced an uncomplicated postoperative course.
Conclusion: This article integrates the features of the presented case with a systematic review of the literature on pheochromocytoma, comprehensively summarizing key diagnostic considerations, therapeutic strategies, and perioperative management protocols to serve as a clinical reference.