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Intraoperative hypertensive crisis due to a catecholamine‐secreting esthesioneuroblastoma
Author(s) -
Salmasi Vafi,
Schiavi Adam,
Binder Zev A.,
Ruzevick Jacob,
Orr Brent A.,
Burger Peter C.,
Ball Douglas W.,
Blitz Ari M.,
Koch Wayne M.,
Ishii Masaru,
Gallia Gary L.
Publication year - 2015
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23907
Subject(s) - esthesioneuroblastoma , catecholamine , medicine , immunohistochemistry , surgery , endocrinology , anesthesia , nasal cavity
Background Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines. Methods We report a patient with a catecholamine‐secreting esthesioneuroblastoma who developed an intraoperative hypertensive crisis. Results A patient with a history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Workup revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade before the second stage. Serum catecholamine levels after this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in catecholamine synthesis, and achaete‐scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons. Conclusion Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma. © 2015 Wiley Periodicals, Inc. Head Neck 37: E74–E80, 2015