Bilateral Pheochromocytoma: An anesthetic challenge

Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. It is bilateral in 10% of cases. A 24 year lady with bilateral Pheochromocytoma operated for resection under epidural with general anesthesia. Diagnosis was confirmed with 24 hour urinary VMA levels, USG, CT scan and MIBG scan. Tumor resection was incomplete on left side so patient underwent reexploration. Preoperative BP controlled with Phenoxybenzamine and Prazocine. Intra-operative BP fluctuations managed with sodium nitropruside and esmolol. Post operative hypotension was tackled with higher doses of Dopamine and Noradrenaline due to down regulation of adrenergic receptors. Patient was discharged on oral steroids after 3 weeks.