Resection of Pheochromocytoma in a Patient Requiring Coronary Artery Bypass Grafting: First Things First
| Autor: | Jacques W.M. Lenders, Joachim Nicolai, Stefan R. Bornstein, Uwe Lindner, Graeme Eisenhofer, Hans Jürgen Weitz, Christina Skondra, Lorenz C. Hofbauer, Matthias Gruber, Manuel Wilbring |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Bypass grafting Phenoxybenzamine business.industry 030209 endocrinology & metabolism General Medicine Disease 030204 cardiovascular system & hematology Surgical procedures RC648-665 medicine.disease Diseases of the endocrine glands. Clinical endocrinology Resection Surgery Pheochromocytoma Coronary artery disease 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure medicine business medicine.drug Artery |
| Zdroj: | AACE Clinical Case Reports, Vol 2, Iss 1, Pp e25-e29 (2016) |
| ISSN: | 2376-0605 |
| DOI: | 10.4158/ep15723.cr |
| Popis: | Objective: Surgical management of critical ischemic heart disease in a patient with a pheochromocytoma poses a significant challenge for endocrinologists, surgeons, and anesthesiologists in terms of the sequence and optimal interval between operations for each condition. This case report exemplifies the practical problem of how to manage two major surgical procedures with their interrelated effects on outcome.Methods: We report on a patient with pheochromocytoma who presented with symptoms of severe multivessel coronary artery disease during medical preparation for pheochromocytoma surgery, requiring coronary artery bypass grafting (CABG).Results: A 74-year-old woman was diagnosed with a symptomatic pheochromocytoma of the right adrenal gland. After 3 days of presurgical preparation with the alpha-adrenoceptor blocker phenoxybenzamine, she presented with symptoms of multivessel ischemic heart disease, for which CABG was required. A successful two-stage procedure was carried out, first performing CABG under protection of phenoxybenzamine, followed by successful laparoscopic adrenalectomy a few weeks later. Both procedures had an uneventful course without major blood pressure fluctuations.Conclusion: Although it is important that the surgical approach is individualized in patients with the concurrent presence of a pheochromocytoma and critical ischemic heart disease, cardiac revascularization under alpha-adrenoceptor blockade prior to pheochromocytoma removal is generally the preferred sequence as this carries the lowest risk of complications.Abbreviations: CABG = coronary artery bypass grafting CAD = coronary artery disease |
| Databáze: | OpenAIRE |
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