Case report of laparoscopic adrenalectomy for a giant pheochromocytoma: medical and surgical challenge

Authors

  • Shikhil Puzhakkal Department of Endocrine Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India
  • Pradeep Puthen Veetil Department of Endocrine Surgery, Baby Memorial Hospital, Kozhikode, Kerala, India https://orcid.org/0000-0002-2415-9644

DOI:

https://doi.org/10.18203/2349-2902.isj20243262

Keywords:

Giant pheochromocytoma, Catechiolamines, Laparoscopic adrenalectomy

Abstract

Pheochromocytomas are rare adrenal tumors that can pose significant clinical challenges due to their potential for catecholamine release and hypertensive crises. We present a case of a large pheochromocytoma managed successfully through a laparoscopic adrenalectomy. A 66-year-old male presented with adrenal incidentaloma. Imaging revealed a sizable left adrenal mass (9.5 cm) consistent with a pheochromocytoma. Preoperative alpha- and beta-adrenergic blockade was initiated to optimize hemodynamic control. The patient underwent a laparoscopic adrenalectomy, with meticulous dissection and adrenal vein ligation to minimize catecholamine release during surgery. Post operatively, blood pressure and catecholamine levels normalized. Histopathological evaluation confirmed the diagnosis of pheochromocytoma with high pheochromocytoma of the adrenal gland scaled score (PASS) and grading of adrenal pheochromocytoma and paraganglioma (GAPP) scoring. Laparoscopic adrenalectomy proved to be a safe and effective approach for managing this large pheochromocytoma, resulting in improved blood pressure control and quality of life for the patient. This case underscores the importance of a multidisciplinary approach, including preoperative medical optimization and close postoperative monitoring, in the management of pheochromocytomas, and contributes to the growing body of evidence supporting laparoscopic techniques for these adrenal tumors.

References

Bogati K, Baniya S, Thapa S, Regmi UK, Karki N, Pokhrel M. A giant pheochromocytoma presenting in pheochromocytoma crisis: a case report. J Nepal Med Assoc. 2023;61(258):179.

Villarraga N, Palani G, Risk M, Sibley S. Unique presentation and perioperative management of a giant pheochromocytoma. JCEM Case Reports. 2023;1(3):65.

Antonio K, Valdez MMN, Mercado-Asis L, Taïeb D, Pacak K. Pheochromocytoma/paraganglioma: recent updates in genetics, biochemistry, immunohistochemistry, metabolomics, imaging and therapeutic options. Gland Surg. 2020;9(1):105-23.

Ambati D, Jana K, Domes T. Largest pheochromocytoma reported in Canada: A case study and literature review. Can Urol Assoc J. 2014;8(5-6):374-7.

Li C, Chen Y, Wang W, Teng L. A case of clinically silent giant right pheochromocytoma and review of literature. Can Urol Assoc J. 2012;6(6):267-9.

Garg MK, Kharb S, Brar KS, Gundgurthi A, Mittal R. Medical management of pheochromocytoma: Role of the endocrinologist. Indian J Endocrinol Metab. 2011;(4):329-36.

Čtvrtlík F, Koranda P, Schovánek J, Škarda J, Hartmann I, Tüdös Z. Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy. Exp Ther Med. 2018;15(4):3151-60.

Fang F, Ding L, He Q, Liu M. Preoperative management of pheochromocytoma and paraganglioma. Front Endocrinol (Lausanne). 2020;11:586795.

Kiernan CM, Du L, Chen X, Broome JT, Shi C, Peters MF, et al. Predictors of hemodynamic instability during surgery for pheochromocytoma. Ann Surg Oncol. 2014;21(12):3865-71.

Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A, et al. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013;11(2):152-6.

Thompson LD. Pheochromocytoma of the Adrenal gland Scaled Score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol. 2002;26(5):551-66.

Koh JM, Ahn SH, Kim H, Kim BJ, Sung TY, Kim YH, et al. Validation of pathological grading systems for predicting metastatic potential in pheochromocytoma and paraganglioma. PLoS One. 2017;12(11):187398.

Yamazaki Y, Gao X, Pecori A, Nakamura Y, Tezuka Y, Omata K, et al. Recent advances in histopathological and molecular diagnosis in pheochromocytoma and paraganglioma: challenges for predicting metastasis in individual patients. Front Endocrinol (Lausanne). 2020;11:587769.

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Published

2024-10-28

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Section

Case Reports