ANESTHESIA FOR COMBINED CESAREAN-SECTION AND EXTRAADRENAL PHEOCHROMOCYTOMA RESECTION - A CASE-REPORT AND LITERATURE-REVIEW

Pheochromocytoma during pregnancy is unusual, with approximately 250 c ases now reported in the literature, The current case describes the an esthetic management of a patient with a large extra-adrenal pheochromo cytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dos e alpha-adrenergic blockade, In this case it is believed that difficul ty in perioperative hemodynamic management was related to mechanical s timulation of the tumor by the gravid uterus. Review of published case reports since 1980 reveals that a pheochromocytoma during pregnancy m ay be diagnosed in an extra-adrenal location relatively more commonly compared to non-pregnant patients. Established criteria exist for the adequacy of alpha- and beta-adrenergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these cri teria apply to pregnant patients with pheochromocytoma, and suggest po ssible modifications to the criteria.