Management of Bilateral Pheochromocytoma: A Case-Based Approach and Review of Literature

The globally increased blood pressure is the silent killer affecting all age groups hampering the day-to-day lives of people. Pheochromocytomas are a rare cause of secondary hypertension. Pheochromocytoma, with a reported incidence of 2-8 per million, is a rare neuroendocrine tumor originating from the chromaffin cells of the adrenal medulla. It can present with a diverse range of clinical manifestations, often mimicking other conditions, making diagnosis challenging. Surgical resection remains the cornerstone of treatment.

The case of a middle-aged female who presented with a hypertensive crisis requiring intensive care unit management was presented. Radiological investigations suggested bilateral pheochromocytoma. A comprehensive diagnostic workup was performed to confirm the diagnosis before proceeding with bilateral adrenalectomy. To mitigate the risk of adrenal insufficiency and subsequent Nelson's syndrome, meticulous postoperative management with mineralocorticoid and glucocorticoid replacement therapy was implemented.

This case highlights the importance of considering pheochromocytoma in the differential diagnosis of adrenal masses, the significance of a thorough preoperative evaluation, and the essential role of postoperative hormonal replacement therapy in ensuring optimal patient outcomes. The study concluded that patients with undiagnosed pheochromocytoma may present in extremis to an emergency department with a pheochromocytoma crisis and coexisting metabolic, thromboembolic, or surgically emergent events. These patients ultimately require coordination with complex critical care and optimization for definitive surgical management, which begins in the emergency department.