PMID- 35795034
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 12
DP  - 2022
TI  - Case Report: Surgical Intervention Under Pheochromocytoma Multisystem Crisis: 
      Timing and Approach.
PG  - 908039
LID - 10.3389/fonc.2022.908039 [doi]
LID - 908039
AB  - BACKGROUND: Progressive multiple organ failures still occur in some patients with 
      pheochromocytoma multisystem crisis (PMC) despite alpha- and beta-blockade being used, 
      and emergency adrenalectomy may lead to rapid hemodynamic stabilization and 
      recovery. Therefore, the optimal timing and surgical approach under PMC remain 
      controversial. CASE PRESENTATION: A 50-year-old man presented with persistent 
      chest pain accompanied by vomiting and headache. CT showed a right adrenal mass, 
      and plasma catecholamine levels were significantly elevated. Phenoxybenzamine was 
      used, but his symptoms were aggravated. He progressed to acute respiratory 
      distress syndrome (ARDS) and received mechanical ventilation. Reexamination of CT 
      showed pheochromocytoma rupture. Emergency pheochromocytoma resection was 
      performed on the 5th day, and he was discharged on the 21st day. A 46-year-old 
      woman was admitted for intrauterine device removal and received hysteroscopy 
      under intravenous anesthesia. She presented with dyspnea, fluctuating blood 
      pressure, and loss of consciousness 9 h after hysteroscopy surgery. CT showed a 
      left adrenal mass, and plasma catecholamine levels were significantly elevated. 
      Her condition fluctuated and could not meet the preoperative preparation criteria 
      for pheochromocytoma despite adequate doses of alpha-blockade and beta-blockade were 
      taken. Furthermore, her lung condition worsened due to recurrent crises and 
      pulmonary edema. After multidisciplinary discussions, laparoscopic left 
      adrenalectomy with venoarterial extracorporeal membrane oxygenation (VA-ECMO) 
      support was performed on the 28th day, and she was discharged on the 69th day. 
      CONCLUSION: Elective surgical resection is the essential therapy for PMC with 
      adequate preoperative medical management. Emergency surgery is recommended for 
      patients who fail to achieve medical stabilization or progressive organ 
      dysfunction within 1 week, especially those with tumor rupture and uncontrolled 
      bleeding. The laparoscopic approach may represent an option even under PMC.
CI  - Copyright (c) 2022 Luo, Cui and Wang.
FAU - Luo, Shengjun
AU  - Luo S
AD  - Urology Department, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
FAU - Cui, Qingao
AU  - Cui Q
AD  - Urology Department, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
FAU - Wang, Delin
AU  - Wang D
AD  - Urology Department, The First Affiliated Hospital of Chongqing Medical 
      University, Chongqing, China.
LA  - eng
PT  - Case Reports
DEP - 20220620
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC9252594
OTO - NOTNLM
OT  - VA-ECMO
OT  - emergency surgery
OT  - laparoscopy
OT  - pheochromocytoma
OT  - pheochromocytoma multisystem crisis
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/07/08 06:00
MHDA- 2022/07/08 06:01
PMCR- 2022/01/01
CRDT- 2022/07/07 02:18
PHST- 2022/03/30 00:00 [received]
PHST- 2022/05/19 00:00 [accepted]
PHST- 2022/07/07 02:18 [entrez]
PHST- 2022/07/08 06:00 [pubmed]
PHST- 2022/07/08 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2022.908039 [doi]
PST - epublish
SO  - Front Oncol. 2022 Jun 20;12:908039. doi: 10.3389/fonc.2022.908039. eCollection 
      2022.