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<p>Giant pheochromocytomas are incredibly rare neuroendocrine tumours of the adrenal medulla. They can often be clinically silent, presenting with only vague abdominal symptoms. Diagnosis is often difficult owing to atypical presentations and normal biochemical analysis. Failure to diagnose these tumours can be catastrophic for the patient, with even a risk of death due to hypertensive crisis, aptly earning them the title of “Ticking Time Bomb”. We encountered a total of 5 patients at our centre, with the average patient age being 42.6 SD 12.17&#xa0;years. There was a female preponderance, with 4 of the 5 cases being women. Only one of the patients presented with the classical triad of headache, palpitation, and diaphoresis, with the other 4 presenting with&#xa0;vague symptoms. Clinical suspicion, biochemical analysis, and imaging studies form the pillars of diagnosis. Preoperative optimisation is of utmost importance. Surgical resection forms the mainstay of treatment, with an open transperitoneal approach being more practical in view of the large size of these tumours. Close communication between the surgeon and the anaesthetist is paramount, with close tracking of blood pressure and serum electrolytes both intra- and postoperatively. Lifelong follow-up on an annual basis is warranted in view of the risk of recurrence, with cross-sectional imaging like computed tomography (CT), magnetic resonance imaging (MRI) and biochemical analysis using plasma/urinary metanephrines forming the mainstay of monitoring for recurrence.</p>

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Negotiating the Challenges in Management of Giant Pheochromocytoma: A Single Centre Experience

  • 期刊论文

  • 发表日期：

    2025年9月8日

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  • Abhijit Golash,
  • Dhritiman Maitra,
  • Adrija Basak,
  • Subhrajit Nath

摘要

Giant pheochromocytomas are incredibly rare neuroendocrine tumours of the adrenal medulla. They can often be clinically silent, presenting with only vague abdominal symptoms. Diagnosis is often difficult owing to atypical presentations and normal biochemical analysis. Failure to diagnose these tumours can be catastrophic for the patient, with even a risk of death due to hypertensive crisis, aptly earning them the title of “Ticking Time Bomb”. We encountered a total of 5 patients at our centre, with the average patient age being 42.6 SD 12.17 years. There was a female preponderance, with 4 of the 5 cases being women. Only one of the patients presented with the classical triad of headache, palpitation, and diaphoresis, with the other 4 presenting with vague symptoms. Clinical suspicion, biochemical analysis, and imaging studies form the pillars of diagnosis. Preoperative optimisation is of utmost importance. Surgical resection forms the mainstay of treatment, with an open transperitoneal approach being more practical in view of the large size of these tumours. Close communication between the surgeon and the anaesthetist is paramount, with close tracking of blood pressure and serum electrolytes both intra- and postoperatively. Lifelong follow-up on an annual basis is warranted in view of the risk of recurrence, with cross-sectional imaging like computed tomography (CT), magnetic resonance imaging (MRI) and biochemical analysis using plasma/urinary metanephrines forming the mainstay of monitoring for recurrence.