Hypertensive crisis during adrenalectomy in a patient with pheochromocytoma and a HOCM with SAM.

Adrenalectomy for pheochromocytoma (PCC) is generally performed after preparation with αand β-sympathicolytic agents to blunt the effects of the elevated catecholamine output. In patients also known to have hypertrophic cardiomyopathy, this preoperative workup needs more attention than in other patients with PCC. This is illustrated by the following case, in which the perioperative pass through Scylla (blunting catecholamine effects to allow adrenalectomy, potentially inducing hypotension and relative hypovolemia) and Charybdis (preventing hypovolemia and hypotension and maintaining sufficient afterload to prevent aortic outflow obstruction) lead to a hypertensive crisis during adrenalectomy.