Pheochromocytoma as an unexpected anesthesia complication
Bauer, G.
Der Anaesthesist 35(10): 628-633
1986
ISSN/ISBN: 0003-2417 PMID: 3789391 Document Number: 285776
A 51 year old woman patient with undiagnosed hypertension and established diabetes mellitus was to undergo hysterectomy. The induced neurolept-analgesia was interrupted because of sudden increase in the heart rate. Plasma adrenaline and noradrenaline values showed an approximately 12-fold increase. With signs of an extreme peripheral vasoconstriction, the patient died about 11 h after the start of anaesthesia. The post-mortem revealed an apricotsized, hormonally active pheochromocytoma of the left suprarenal body. Following investigation of the pathophysiological and pharmacological process, the case is analyzed from the medico-legal view, the non-clarification of the hypertension as objective failure to exercise due care is put up for discussion, and the question of causality and imputation discussed. Anesthesia in the presence of an undetected pheochromocytoma may be so rare that the criterion of adequacy, i.e. the objective predictability, cannot be applied. None the less the case demonstrates once again the physician's special duty to exercise due care. A precondition for any responsible choice of therapy must be accurate and comprehensive compilation of the findings.