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Pheochromocytoma is a rare catecholamine secreting tumor of the chromaffin of the body derived from the neural crest tissue and accounts for 0.1% to 1% of all cases of chronic hypertension (Manger et al, 1985). The common presenting signs and symptoms are paroxysmal hypertension, headache, excessive sweating, and palpitation. The hypertension is episodic in nature in up to 50% of cases. Also, 10% of patients remain normotensive (Bravo & Gifford, 1984). Thus, pheochromocytoma may go unrecognized and up to 50% of the cases are diagnosed only at postmortem examination. A proportion of patients are diagnosed at the time of incidental surgery, when induction of anesthesia and surgical manipulations may precipitate catastrophic hemodynamic crisis and even multiple organ failure (Siddik-Sayyid et al. 2007; Dabbous et al.2007; O’Riordan JA, 1997). In this situation, mortality is close to 80% (O’Riordan, 1997). The dramatic improvement in surgical outcome of diagnosed pheochromocytoma can be attributed to adequate preoperative imaging, appropriate medical preparation, and improved surgical and anesthetic techniques (Schiff & Welsh, 2003).

Undiagnosed Pheochromocytoma Complicated with Perioperative Hemodynamic Crisis and Multiple Organ Failure