Management of Pheochromocytoma in The Setting of Acute Stroke
Management of Pheochromocytoma in The Setting of Acute Stroke
Blog Article
ABSTRACT: Objective: Stroke is a rare presenting symptom of pheochromocytoma; therefore, a balance between adequate pre-operative medical blockade and expedition of surgery to minimize the risk of further peri-operative stroke is needed.However, currently there are no established guidelines regarding timing of surgery or length of pre-operative blockade in these patients.We report a case of pheochromocytoma in a 53-year-old woman presenting with a hemorrhagic transformation of an ischemic stroke.We describe the clinical course, diagnosis, and management of our case and then discuss similar cases in the literature as well as optimal pre-operative management.Methods: We review all clinical data and describe the Oil Warmers patient presentation and treatment.
A comprehensive literature review of the topic is discussed.Results: Pheochromocytoma in our patient presented as a combination of stroke, severe hypertension, and tachycardia.A computed tomography scan, evaluation of catecholamine levels, and 123iodine-labeled metaiodobenzylguanidine scan confirmed pheochromocytoma.Hemodynamic stability was achieved after 9 weeks of treatment with selective alpha-blockade and other antihypertensive medications, after which laparoscopic transabdominal adrenalectomy was performed.Despite a normal blood pressure at pre-induction, the patient experienced 6 episodes of severe hypertension intra-operatively.
There were no operative complications and hypertension resolved postoperatively.A review CUCCUMBER of the literature identified 5 similar cases; however, the optimal management of these patients remains unclear.Conclusion: Our case highlights the importance of including pheochromocytoma in the differential diagnosis of patients with stroke.Optimal results may be achieved by ensuring at least 6 weeks of recovery following stroke, and inducing orthostatic hypotension for at least 2 weeks prior to the surgery.Abbreviation: CT computed tomography.