A case of ectopic pheochromocytoma of pulmonary origin

A 55-year-old woman with pulmonary tumor was scheduled for tumor resection. Preoperatively, her episode of paroxysmal hypertension suggested the existence of pheochromocytoma, but MIBG (metaiodo-benzylguanidine) scintigraphy revealed no local accumulation. Therefore, physicians and surgeons denied the possibility of pheochromocytoma. During epidural catheterization, hypertension occurred, which was controlled by diltiazem 2 mg. Anesthesia was induced with midazolam 10 mg, propofol 70 mg and fentanyl 300 microg and maintained with propofol 4-7 mg x kg(-1) x hr(-1), epidural block with 1% mepivacaine and nitrous oxide 66% in oxygen. Manipulation of the tumor induced hypertension. Diltiazem 1-2 microg x kg(-1) x min(-1) and nicardipine 0.4-4 microg x kg(-1) x min(-1) were administered. After tumor resection, blood pressure decreased to 82/42 mmHg and norepinephrine 0.05-0.25 microg x kg(-1) x min(-1) was infused. Norepinephrine infusion was continued for 24 hours after surgery. She was discharged from the recovery room on the third postoperative day without any complications. A case of ectopic pheochromocytoma of pulmonary origin was managed with midazolam, propofol, fentanyl and continuous epidural block. Diltiazem, nicardipine and norepinephrine were administered to control blood pressure.