Anesthetic management of a patient with undiagnosed paraganglioma -a case report-

Abstract

Retroperitoneal paragangliomas are uncommon neuroendocrine tumors which are derived from extra-adrenal paraganglioma with various clinical signs and symptoms. Although most extra-adrenal paragangliomas are histologically benign, some tumors can synthesize and secrete excess catecholamine from the tumor. Excessive production of catecholamine causes numerous cardiovascular manifestations such as severe hypertension, cardiomyopathy, cardiac arrhythmias, and even multiorgan failure. It can lead to high risks of morbidity and mortality, especially in patients who are unrecognized or not adequately prepared. We present a female patient who was preoperatively undiagnosed of secreting retroperitoneal paraganglioma that caused cardiac tachyarrhythmia and severe intraopertive hypertension not controlled by usual antihypertensive agents. A secreting extra-adrenal paraganglioma should be included in differential diagnosis for patient who have incidentaloma and show wide range of hypertension with hemodynamic instability that is not well controlled by common antihypertensive drugs.

Anesthetic Management of a Large Retroperitoneal Paraganglioma: A Rare Case Report

“…The anesthetic management of the surgical excision of the tumor requires the knowledge of physiological and pathological effects of catecholamine secreting tumors under the influence of anesthesia and surgery as they have a significant effect on the outcome of the surgery [13]. Excessive catecholamine production and secretion in the circulation poses serious lifethreatening cardiovascular complications like hypertension, myocardial infarction, pulmonary edema, arrhythmias, and cardiomyopathy [14]. The major anesthetic concerns include adequate preoperative optimization of the blood pressure, safe conduct of anesthesia, smooth intubation and extubation attenuating the stress response, maintaining hemodynamic stability, supplementation of steroids, monitoring glycaemic status and providing balanced multimodal analgesia [15].…”

Hypertensive crisis of a patient with undiagnosed paraganglioma

“…It is thought to be due to the sudden release of excess catecholamine contained in paraganglioma, which is mistaken for GIST. Most report considerable hemodynamic stability during induction and maintenance of anesthesia using inhalation anesthesia and opioids, but experience a hypertensive crisis at the moment the mass is maneuvered [7,10]. In a case described in 2009, Lowenthal et al [6] reported that the tumor located near the stomach was mistaken for GIST, but they experienced a hypertensive crisis as soon as the initial operational step for tumor removal was performed for resection.…”