Pheochromocytoma in a patient with end-stage renal disease

Pheochromocytoma is a rare tumor. To our knowledge only 15 cases have been reported in patients with end-stage renal disease (ESRD). We describe a 46- year-old woman with ESRD and a history of paroxysmal and difficult-to-contr ol hypertension. During anesthesia for a surgical procedure, the patient ex perienced blood pressure lability with systolic blood pressures ranging fro m 76 to 360 nun Hg. Serum catecholamine concentrations were 2698 pg/mL (ref erence value, < 750 pg/mL) for norepinephrine, 33 pg/mL (< 110 pg/mL) for e pinephrine, and 55 pg/mL (< 30 pg/mL) for dopamine. The concentrations of p lasma metanephrines were 6.84 nmot/L (<0.50 nmol/L) for metanephrine and 14 .64 nmol/L (<0.90 nmol/L) for normetanephrine. Abdominal computed tomograph y showed a right-sided, 4-cm mass posterior to the infrahepatic inferior ve na cava. Following blood pressure control with alpha- and beta -adrenergic blockade, the mass was removed. Pathologic examination demonstrated the mas s was a pheochromocytoma. The maximum postoperative systolic blood pressure was 160 mm Hg. Postoperative plasma normetanephrine concentration was 2.80 nmol/L, and metanephrine was obscured by interfering substances. This case report and literature review emphasizes the difficulty in diagnosing pheoc hromocytomas in patients with ESRD despite the myriad of available diagnost ic tests.