PHEOCHROMOCYTOMA

1. D I R E C T O R : D R . S . C . G A N E S H P R A B U M . D , D . A
C H I E F : D R . E V E L Y N A S I R V A T H A M M . D , D C H
A S S I S T A N T : D R . K A R P A G A V A L L I M . D , D . A ,
D R . B . M A N I K A N D A N D N B ,
P R E S E N T O R : D R . P . S A L A M O N R A J A P G
INTERESTING CASE
PRESENTATION
PHEOCHROMOCYTOMA

2. CASE -1
 PETCHIYAMMAL, 52/F,
 c/o headache ,palpitation, abdominal swelling past 6
months.
 Diagnosed as ? Retroperitoneal mass, ? Adrenal
tumor.
 Posted for surgery on 17.07.2015.
 Pre op assessment : no comorbid conditions ,
investigations with in normal limits, assessed under
ASA II .

3.  ON THE DAY OF SURGERY :
 patient conscious, oriented,
 PR: 86/MIN, BP : 130/80 mmhg
 Patient was taken under EPI+ GA
 IJV CANNULATED with 7 fr CVP catheter .
 Left radial artery cannulated for arterial pressure
monitoring.

4.  Intra op findings :
 a cystic mass above the left kidney .
 BP fluctuation through out the procedure whenever
they manipulate the swelling .
 BP ranges 80-220/40-140 mmhg .
 BP CONTROL achieved by INJ. NTG & epidural top
up.
 AFTER EXCISION of tumor , sudden BP fall was
there which was managed with inj .DOPAMINE
INFUSION.

5.  POST OP :
 Patient sedated & paralysd , vitals stable, patient
shifted to IRCU for post op elective ventilaton.
 Patient extubated on 18.7.2015 .
 Transfer out to ward on 22.07.2015.
 BIOPSY REPORT : MALIGNANT
PHEOCHROMOCYTOMA .

6. Case -2
 Kanimozhi , 32/F
 C/O PAIN & SWELLING in abdomen for the past 3
months .
 Diagnosed as ? Retroperitoneal mass, ? Adrenal
mass .
 Case posted for surgery on 2.7.15.
 Pre op assessment : no comorbid conditions ,
investigations with in normal limits , assessed
underASA I.

7.  ON THE DAY OF SURGERY :
 patient conscious, oriented,
 PR : 89/ min , BP : 110/70 mmhg.
 Patient was taken under EPI+GA,
 Right IJV cannulated with 7 fr cvp catheter.
 Intra op findings: a retro peritoneal mass measuring 8x8.
cm extending in to thorax( p0sterior mediastinum) .
 Cardio thoracic surgeon call over given . Mass excised.
 BP fluctuation was there , but it may to compression of
heart by retractor used by surgeon.

8.  Post op :
 patient sedaded & paralysed,
 PR : 92/MIN, BP: 110/70 mmhg.
 Patient shifted to IRCU for elective post op
ventilation.
 Patient extubated on 3/7/2015 & transfer out to
ward on 4/7/2015.
 BIOPSY REPORT: NON FUNCTIONAL
MALIGNANT PARAGANGLIOMA .

9. DISCUSSION
 PHEOCHROMOCYTOMA :
 an adrenal medulla tumor,
 10% in population , 10% bilateral,10% malignant.
 Symptoms presenting with headache, palpitations
which may be occasional.
 Malignant hypertention was there which also be
occasional.
 Most of the patients were asymptomatic.
 Investigations : VMA positve in urine.

10.  Proper preparaton of patient before surgery is
essential to decrease intra op as well as post op
morbidity & mortality.
 Alpha blockers( noradrenaline) & beta – blockers(
adrenaline) were useful for pre op optimization of
catecholamines .