Double trouble – refractory hypertension during adrenalectomy due to an accessory vein: a case report

Abstract

Pheochromocytoma is a rare tumor that releases catecholamines. The symptoms include hypertension, paroxysmal headaches, diaphoresis and palpitations. The diagnosis is made with elevated catecholamines and a suprarenal mass in abdominal CT scan. The treatment includes pharmacological preparation, with suppression of the adrenergic receptors, and adrenalectomy. The most important step during surgery is the resection of adrenal vein. After that, the release of catecholamines is totally suppressed. This results in hypotension or even shock. We present an adrenalectomy, in which invasive arterial pressure monitoring acknowledge hemodynamic changes that were not expected. This allowed surgeons to realize there was an accessory vein.

Keywords: Adrenalectomy; Anatomical variation; Hypertension; Pheochromocytoma; Adrenal vein.

Citation: Morgado C, Inácio R, Marques CN. Double trouble – refractory hypertension during adrenalectomy due to an accessory vein: a case report. Anaesth. pain intensive care 2024;28(2):388−390; DOI: 10.35975/apic.v28i2.2414

Received: October 06, 2023; Revised: February 27, 2024; Accepted: March 06, 2024