Baio Raffaele, Pagano Tommaso, Molisso Giovanni, Di Mauro Umberto, Intilla Olivier, Albano Francesco, Scarpato Fulvio, Giacometti Stefania, Sanseverino Roberto
Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, I-84081 Salerno, Italy.
Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy.
Diseases. 2022 May 17;10(2):29. doi: 10.3390/diseases10020029.
Pheochromocytoma is known for its instantaneous presentation, especially in the younger population. Hemodynamic instability may be the cause of severe complications and impede patients' ability to undergo surgical treatment. These tumours are surgically difficult to treat due to the risk of catecholamine release during their manipulations, and when they are large, the tumour size represents an additional challenge. In our report, cardiogenic shock developed due to increases in systemic vascular resistance, and the lesion's size induced surgeons to perform open surgery.
A 46-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Systolic dysfunction was noted, along with severely increased systemic vascular resistance. A CT scan showed a left-sided 8.5 cm adrenal mass, which was confirmed as pheochromocytoma using meta-iodobenzylguanidine scintigraphy. Anaesthesiologists and the surgical team planned an effective strategy of treatment. Given the lesion's size and its apparent invasion of the neighbouring organs, open adrenalectomy (after prolonged hemodynamic stabilisation) was considered safer. The surgery was successful, and the patient remains free from disease two years after the initial event.
Large pheochromocytoma can be safely and effectively treated with open surgery by experienced hands but only by seeking to reach hemodynamic stabilisation and minimising the release of catecholamine before and during surgery.
嗜铬细胞瘤以其突发症状而闻名，尤其是在年轻人群中。血流动力学不稳定可能是严重并发症的原因，并阻碍患者接受手术治疗。由于在操作过程中存在儿茶酚胺释放的风险，这些肿瘤手术治疗困难，而且当肿瘤较大时，肿瘤大小更是一项额外挑战。在我们的报告中，由于全身血管阻力增加导致心源性休克，且病变大小促使外科医生进行开放手术。
一名46岁女性患者因高血压入院，后发展为心源性休克，入住我们的重症监护病房。发现存在收缩功能障碍，同时全身血管阻力严重增加。CT扫描显示左侧肾上腺有一个8.5厘米的肿块，经间碘苄胍闪烁扫描确诊为嗜铬细胞瘤。麻醉医生和手术团队制定了有效的治疗策略。鉴于病变大小及其对邻近器官的明显侵犯，开放肾上腺切除术（在长时间血流动力学稳定后）被认为更安全。手术成功，患者在初次发病两年后仍无疾病复发。
经验丰富的医生通过开放手术能够安全有效地治疗大型嗜铬细胞瘤，但前提是要在手术前和手术期间实现血流动力学稳定并尽量减少儿茶酚胺的释放。
