Objective: Pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla. The clinical sign is variable. Classical symptoms include palpitations, headaches, sweating, and paroxysmal hypertension as a result of elevated cathecolamine production. This case report aims to describe the clinical presentation, management, and outcome of phaechromocytoma.
Case: A 14 year-old boy presented to the pediatric emergency department with hypertensive crisis (blood pressure 220/140 mmHg). He had recurrent tension headache, excessive sweating, palpitation and weight lost during the last 1 year. Twenty four hour urinary catecholamine level was normal. Clinical suspicion of pheochromocytoma was confirmed by abdominal CT scan. After having preoperative treatment with nicardipine infusion, oral nifedipine,and oral captopril, bilateral cortical sparing adrenalectomy was done. Nicardipine infusion was administered to maintain the blood pressure during surgery. Intraoperative hypotension was noted when ligated the tumor and treated with fluid replacement along with vasopressor and inotropic infusion. Histopathology confirmed the diagnosis of adrenal pheochromocytoma. Adrenocortical was preserved and the patient did not require steroid in post-operative period following the operation. Complete resolution of hypertension was achived gradually after one month and the patient remained normotensive without any medication.
Conclusion: Pheochromocytomas are rare but potentially life-threatening disease. Prompt recognition and appropiate management of pheochromocytomas are important. Multidisciplinary team during preoperative, intraoperative, and postoperative are required for successful outcome.