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

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.BACKGROUNDUndiagnosed 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.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.OBSERVATIONSThe 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,