Perioperative management of patients with glioblastoma copresenting with pheochromocytoma: illustrative case.

Background: Undiagnosed pheochromocytoma can present with hemodynamic instability during surgical procedures. Here, the authors discuss a 69-year-old male with isocitrate dehydrogenase (IDH)-wildtype glioblastoma copresenting with undiagnosed pheochromocytoma, which, to the authors' knowledge, is the second reported case in the literature.

Observations: The patient presented to the emergency department with a 1-month history of coordination difficulties, progressive morning headache, and mild left-side weakness. Imaging showed a 5-cm peripherally enhancing intra-axial right parietal mass with surrounding vasogenic edema. Intraoperatively, the patient had significant uncontrollable hypertension up to 240/120 mm Hg, and the operation was promptly aborted. Contrast-enhanced computed tomography imaging of the chest, abdomen, and pelvis identified a 4.9-cm left adrenal mass of indeterminant etiology. Endocrinology diagnosed the incidentaloma as a pheochromocytoma, initiating alpha blockade followed by beta blockade, and the urology service performed a laparoscopic adrenalectomy after patient stabilization. The neurosurgery service removed the intra-axial brain lesion 2 days after adrenalectomy, which was diagnosed as IDH-wildtype glioblastoma. The patient was discharged home after 6 days in stable condition.

Lessons: This case highlights the importance of preoperative screening for pheochromocytoma in neurosurgical patients with adrenal incidentalomas, especially in incidentalomas > 4 cm, even without high clinical suspicion. https://thejns.org/doi/10.3171/CASE24374.