Endocrine Abstracts

Pheochromocytomas are rare chromafin, catecholamine-producing neuroendocrine tumors that arise from the adrenal medulla. Nearly half of these tumors are presented as an unexplained death and autopsy reports indicate higher incidence than it is proposed. We report the case of patient with pheochromocytoma treated only with minimal dose prazosin for twelve years. The operation was cancelled twice, on the day of surgery because the patient was not prepared with alpha-blockers and paroxysmal high blood pressure had happened. The patient was treated with 1 mg prazosin per day, and was not refer to an endocrinologist. He experienced episodic and sudden onset of high blood pressure that exceeds 270/130 mmHg, with dizziness, severe headache, tachycardia and sweating. The paroxysms have occurred two-three times a month. Diagnoses of diabetes mellitus and CKD were set in the meanwhile. The patient was admitted to the Department of Endocrinology of University Clinical Center of Republic of Srpska at the beginning of 2019. CT evaluation showed big, heterogeneous tumor mass, approximately 12×13×10 cm with 140 HU after i.v. contrast administration. In 24-h urinary collection adrenaline was five fold higher and noradrenaline was three times above the upper reference limit. Excretion of dopamine in 24-h urinary collection was in reference range. Phenoxybenzamin was initiated as starting dose of 10 mg and was gradually increased to 40 mg/day prior the operation. Also, 0.9% NaCl was gradually increased up to maximal 3.5 l/day to avoid the orthostatic hypotension. Two units of blood transfusion were given 48h before surgery and Low dose of bisoprolol was introduced in the therapy. Open resection was performed 15th. Any anaesthesia-related complications were recorded during surgery. The real tumor size was 16×14×12 cm. Postoperative, blood pressure was stabilized with noradrenaline.