Guo Jian, Qiu Yuting, Zhang Xiaojin, Qian Yitao, Xu Jianhong
Department of Anaesthesiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000, China.
Department of Obstetrics, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000, China.
BMC Anesthesiol. 2024 Dec 19;24(1):463. doi: 10.1186/s12871-024-02850-w.
Pheochromocytomas (PCCs) are rare neuroendocrine catecholamine (CA)-secreting tumours that originate from chromaffin tissue and can produce and store CAs. Unexpected PCCs pose a serious threat to the perioperative safety of patients and a considerable challenge to anaesthesiologists because of the risks of fatal hypertensive crises and other stresses.
A 37-year-old woman who was scheduled for tonsillectomy and palatopharyngoplasty under general anaesthesia experienced a malignant cardiovascular event after induction, which was characterized mainly by a sharp increase in heart rate and blood pressure, ultimately leading to cardiac arrest and the occurrence of secondary long QT syndrome. Based on the perioperative clinical manifestations, measurements of plasma and urinary CAs, postoperative bilateral adrenal computed tomography results and surgical pathological results, the patient was diagnosed with an undiagnosed PCC.
Anaesthesiologists should pay attention to patients with recurrent chest tightness, as these patients may have an undiagnosed PCC. Extreme hypertension and tachycardia during the perioperative period may indicate a PCC. We should not automatically use beta-adrenergic receptor blockade while overlooking the importance of alpha-adrenergic receptor blockade. If a serious malignant cardiovascular event occurs in patients with an undiagnosed PCC during the perioperative period, multidisciplinary comprehensive treatment is crucial.
嗜铬细胞瘤（PCCs）是一种罕见的神经内分泌性儿茶酚胺（CA）分泌肿瘤，起源于嗜铬组织，可产生并储存儿茶酚胺。隐匿性嗜铬细胞瘤对患者围手术期安全构成严重威胁，因其存在致命性高血压危象及其他应激风险，给麻醉医生带来巨大挑战。
一名37岁女性计划在全身麻醉下行扁桃体切除术和腭咽成形术，诱导后发生恶性心血管事件，主要表现为心率和血压急剧升高，最终导致心脏骤停及继发性长QT综合征的发生。根据围手术期临床表现、血浆和尿儿茶酚胺测定、术后双侧肾上腺计算机断层扫描结果及手术病理结果，该患者被诊断为未被诊断出的嗜铬细胞瘤。
麻醉医生应关注反复出现胸闷的患者，因为这些患者可能患有未被诊断出的嗜铬细胞瘤。围手术期出现极度高血压和心动过速可能提示嗜铬细胞瘤。我们不应在忽视α-肾上腺素能受体阻滞剂重要性的同时，自动使用β-肾上腺素能受体阻滞剂。如果在围手术期未被诊断出嗜铬细胞瘤的患者发生严重的恶性心血管事件，多学科综合治疗至关重要。
