Acute and Critical Care

Case Reports

A Case of Functioning Paraganglioma Mimicking Anaphylactic Shock: A Case Report: Ju Young Han, Oh Hyun Lee, Gyung Eun Kim, Seung Baik Han, So Hun Kim, Moonsuk Nam, Yong Seong Kim, Seongbin Hong; Korean J Crit Care Med. 2013;28(2):152-155.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.152

Abstract PDF: Paraganglioma is a tumor originating from the extra-adrenal chromaffin cells, and functional paraganglioma causes paroxysmal hypertension, headache and tachycardia, due to excess excretion of catecholamine. However, rarely, ARDS, acute myocardial infarction, heart failure, arrhythmia, and pulmonary edema are also seen in patients with paraganglioma and clinical manifestations are depending on the patient's intravascular volume status. Seventy one-years-old male was presented with hypotension and pulmonary edema after intravenous midazolam injection during colonoscopy under conscious sedation. The patient was initially suspected with anaphylactic shock, due to midazolam injection. However, later, he was diagnosed with paraganglioma, and blood pressure was successfully controlled with alpha adrenergic blockade. We suggest that when we encounter heart failure, pulmonary edema and shock of unknown origin, pheochromocytoma must be taken into consideration.

Hypertensive Crisis during Removal of Retroperitoneal Mass in a Patient with Undiagnosed Paraganglioma - A Case Report -: Hee Young Kim, Joo Yun Kim, Hae Kyu Kim, Seung Hoon Baek; Korean J Crit Care Med. 2013;28(1):64-66.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.64

Abstract PDF: Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient's hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.

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