Surgical Approach of Hypertension: Pheochromocytoma - Case Report

Pheochromocytoma is present in about 1% of hypertensive patients. It has a 90% cure potential, but a high mortality rate if left untreated. Complications include malignant hypertension, heart failure, myocardial infarction, ventricular arrhythmias, stroke or metastasis (malignant pheochromocytoma). We present the case of a 47-year-old hypertensive female patient who was admitted to hospital in 2014 with excessive fluctuations in blood pressure (300/140 mmHg to 90/50 mmHg), rapid pulse not responding to medication, profuse night sweats, palpitations, vertigo, nausea, and vomiting. The patient had a history of high arterial pressure dating back to 1996, following complex anti-hypertensive treatment, and frequent episodes of paroxysmal atrial fibrillation in the previous four years, reduced by external electric shock. Laboratory and imaging investigations revealed a solid-type formation with mixed structure in the right adrenal gland, indicating pheochromocytoma. Surgery with resection of the right adrenal gland was proposed. Preoperative preparation to combat the risks of large variations in blood pressure and hypovolemia started 1–3 weeks before surgery, consisting of an alpha-blocker to control blood pressure, a betablocker to prevent arrhythmic events, and hydration to prevent postoperative hypotension. A right adrenalectomy was performed. Histopathology of the resected piece confirmed the diagnosis of pheochromocytoma. After surgery, the large variations in blood pressure, arrythmic events and tumor symptoms were all reduced, and blood pressure returned to within normal range. Follow-up treatment consisted of Carvedilol 12.5 mg, 1 cp / day and a low-salt, hypolipidaemic diet was recommended. The case is notable for the late diagnosis made about 18 years after the onset of the hypertensive symptoms, treated with excessive medication.