Continuous Hemodiafiltration for Pheochromocytoma Crisis with a Positive Outcome

Abstract

A 38-year-old woman who consulted a local doctor with chief complaints of sudden palpitations, headaches, and chest pain is herein presented. After admission, pheochromocytoma crisis was suspected. Since the patient had a history of acute heart failure and had once survived an episode of cardiac arrest, a rapid decrease in the catecholamine levels was needed. After resuscitation, pharmacological therapy with agents such as phentolamine and landiolol was administered, and continuous hemodiafiltration (CHDF) was performed to reduce the catecholamine levels. Elective surgery was then performed, and a positive outcome was achieved. This case suggests that the preoperative use of CHDF to control pheochromocytoma crisis may therefore be effective.

Emergent transcatheter arterial embolization to control critical blood pressure fluctuation associated with hypercatecholaminemic crisis in a patient with an unruptured retroperitoneal paraganglioma

“…Ohara and colleagues reported spontaneous resolution of severe BP fluctuation within 2 weeks after the onset, with normalization of plasma catecholamine levels and no uptake of MIBG into the tumor, secondary to completion of the extensive necrosis [11] . Otherwise, particularly when emergent surgery and medical control using alpha-1 blockade bear high risk, treatment might comprise mechanical circulatory support with a cardiopulmonary device or intra-aortic balloon pump and/or removal of catecholamines by continuous hemodiafiltration [28] , [29] , [30] , [31] , [32] . Alternatively, we chose to perform emergent TAE, which swiftly controlled the critical BP fluctuation, and ultimately performed elective surgical tumor resection.…”