Pheochromocytome a localisation para-renale revelee par une hypertension arterielle maligne: a propos d'un cas

Les auteurs rapportent un cas de pheochro-mocytome ectopique. Cas clinique : patiente de 29 ans; hypertendue connue depuis 8 ans et diabetique depuis 7ans; admise en urgence pour perte de connaissance. L'examen clinique a montre une pression arterielle a 190/130mmHg; un pouls a 116 battements/minute et un Glasgow a 7 sans deficit hemi corporel. L'examen du fond d'oil a mis en evidence des signes de retinopathie hypertensive stade III. Le dosage plasmatique de la normetanephrine etait de 3917ng/l (normale170) et celui de la metanephrine de 59ng/l(normale73). Le scanner abdominal a montre un processsus tumoral tissulaire para-renal anterieur et polaire superieur gauche; mesurant sur une coupe axiale 73;8 X 51;3mm. Le diagnostic de pheochromocytome a ete pose. Le traitement a consiste a une exerese de la tumeur. L'evolution est favorable. Conclusion : le pheochromocytome para-renal est une cause rare d'hypertension arterielle maligne

Tumeurs des deux surrenales. A propos d'un cas

Les tumeurs surrenaliennes bilaterales sont rares. Nous rapportons un cas de pheochromocytome surrenalien associe a un corticosurrenalome controlateral chez une patiente de 65 ans. L'association d'une hypertension arterielle a des cephalees; sueurs; et palpitations a oriente vers le diagnostic de pheochromocytome. Le bilan biologique base sur le dosage urinaire des derives methoxyles a confirme ce diagnostic. L'echographie et le scanner ont montre la presence de deux masses surrenaliennes bilaterales de structure tissulaire. Les deux masses sont discretement rehaussees apres injection du produit de contraste. Devant ce tableau clinique; biologique et morphologique; le diagnostic de pheochromocytome surrenalien bilateral est retenu. Par consequent une surrenalectomie bilaterale par voie bi-sous-costale a ete realisee. L'examen anatomopathologique a revele la coexistence d'un pheochromocytome sur la piece de surrenalectomie droite et d'un carcinome corticosurrenalien sur la piece de surrenalectomie gauche; ce qui etait imprevu. Les suites operatoires ont ete bonnes; sans recidive; avec un recul de 4 ans. A la lumiere de cette observation et d'une revue de la litterature; nous discutons les differentes caracteristiques de cette association inhabituelle

Phaeochromocytoma and Reversible Myocardial Ischaemia in a 23-year Old Female

Background : Phaeochromocytoma is a rare neuroendocrine tumour with highly variable clinical presentation including serious and potentially lethal cardiovascular complications. Aim: to present a case of myocardial ischaemia in Phaeochromocytoma which was reversed after surgery. Setting: University of Port Harcourt Teaching Hospital (UPTH). Case report: A young female undergraduate aged 23 years presented with recurrent blackouts; paroxysmal hypertension which was resistant to several anti- hypertensive drugs and marked postural drop was referred from a private clinic to UPTH. Rest electrocardiogram (ECG) showed ischaemic changes and right axis deviation. Ultrasound scan and compu- terised tomographic (CT) scan showed a mass on the anteromedial portion of the left kidney with centrally located cystic areas. The 24-hour urine level of vanillyl mandelic acid (VMA) was normal. The tumour was excised by open surgery and histopathological findings confirmed Phaeochromocytoma. The ECG changes reversed after surgical excision. There was no recurrence or metastasis postoperatively after a long term follow up of 5 years. Her blood pressure remained normal postoperatively without taking antihyperten- sive medication. Conclusion: Phaeochromocytoma is a catecholamine secreting neuroendocrine tumour with a high cardiovascular morbidity and mortality. ECG features of myo-cardial ischaemia can be reversed by surgical intervention

Anaesthetic challenges in surgical excision of phaeochromocytoma

Background: Phaeochromocytoma is a rare tumour; which is benign but metabolically active; with a potential for malignancy. This tumour of adrenal or extra adrenal origin usually presents as hypertension; which can be sustained or paroxysmal and with lethal complications. Aim: To present an anaesthetic experience during the surgical resection of a phaeochromocytoma. Method: A 26-year old woman with phaeochromocytoma of the right adrenal gland is presented. The tumour was excised under general anaesthesia. The anaesthesia involved the use of continuous infusion of esmolol (an ultra short-acting intravenous cardioselective beta-antagonist) and propofol. The resected tumour was sent for histopathological examination. Results: The tumour was completely excised under general anaesthesia. The haemodynamic changes that occurred during tumour handling were controlled with fentany1;propofol/esmolol infusion. Histopathological findings confirmed phaeochromocytoma. Conclusion: Although; the anaesthetic and surgical management of a phaeochromocytoma could be an uphill task; it is possible in an environment with limit laboratory and intensive care facilities