Pheochromocytoma manifested as a surgical emergency

Pheochromocytoma is a rare tumour derived from chromaffin cells of the adrenal medulla, derived from embryonic neural crest cells. Pheochromocytoma affects approximately 0.3 %–0.6 % of the hypertensive population. Most cases of pheochromocytomas are sporadic, but they may also be associated with multiple endocrine neoplasia Type II, von Hippel Lindau Syndrome, and less commonly with Neurofibromatosis Type 1. If symptomatic, the clinical presentation of pheochromocytoma is highly variable. The classic presentation of pheochromocytoma involves the triad of paroxysmal headaches, palpitations, and diaphoresis accompanied by marked hypertension. However, pheochromocytoma may rupture either spontaneously or following trauma and mimic surgical emergencies, including acute abdomen and haemorrhagic shock, that may be lethal if not diagnosed promptly. The proper treatment of ruptured pheochromocytoma is elective adrenalectomy after medical or interventional patient stabilization. Emergency adrenalectomy for pheochromocytoma and is associated with significant morbidity and mortality. Emergency adrenalectomy can be complicated by circulatory shock due to excess catecholamine release, cardiomyopathy and adult respiratory distress syndrome.