Surgically correctable hypertension - a case report

Pheochromocytoma and hyperaldosteronism are endocrine causes of surgically correctable hypertension. Other causes include co-arctation of aorta and renal artery stenosis. Approach to the management of pheochromocytoma including per-operative preparation, intra-operative management and post-operative follow-up is unique and distinct from that of other causes of hypertension. A lady aged 45, presented to the OPD with history of dizziness and recurrent fainting attacks. On examination, she was found to be hypertensive. Analysis of a 24-hr urine sample revealed elevated levels of metanephrines. CECT of the abdomen revealed a left adrenal tumour, with an increased uptake on MIBG scintigraphy. She was diagnosed with a left adrenal pheochromocytoma. After pre-operative preparation with an alpha-blocker (Prazosin) and volume expansion, followed by betablockade, she was posted for surgery. A left adrenal pheochromocytoma was excised, which was followed by a sustained drop in blood pressure. The post-operative period was uneventful. She is currently on regular follow-up.Although Phenoxybenzamine is the gold standard, Prazosin was the alpha-blocker used for pre-operative preparation in this patient. It is preferable to employ a trans-peritoneal approach for all adrenal medullary tumours. This is because of the possibility of multiple functional adrenal medullary tumours, which need to be explored and excised in the event of sustained or resurgent hypertension after excision of an apparently solitary functional tumour. This will be facilitated by a trans-peritoneal approach.