Surgically correctable hypertension - a case report

Abstract

Pheochromocytoma and hyperaldosteronism
are endocrine causes of
surgically correctable hypertension.
Other causes include co-arctation of
aorta and renal artery stenosis. Approach
to the management of pheochromocytoma
including per-operative preparation,
intra-operative management and
post-operative follow-up is unique and
distinct from that of other causes of hypertension.
A lady aged 45, presented to
the OPD with history of dizziness and
recurrent fainting attacks. On examination,
she was found to be hypertensive.
Analysis of a 24-hr urine sample revealed
elevated levels of metanephrines.
CECT of the abdomen revealed a left adrenal
tumour, with an increased uptake
on MIBG scintigraphy. She was diagnosed
with a left adrenal pheochromocytoma.
After pre-operative preparation
with an alpha-blocker (Prazosin) and volume
expansion, followed by betablockade,
she was posted for surgery. A
left adrenal pheochromocytoma was
excised, which was followed by a sustained
drop in blood pressure. The post-operative
period was uneventful. She is currently on
regular follow-up.Although Phenoxybenzamine
is the gold standard, Prazosin was
the alpha-blocker used for pre-operative
preparation in this patient. It is preferable to
employ a trans-peritoneal approach for all
adrenal medullary tumours. This is because
of the possibility of multiple functional
adrenal medullary tumours, which
need to be explored and excised in the
event of sustained or resurgent hypertension
after excision of an apparently solitary
functional tumour. This will be facilitated by
a trans-peritoneal approach.