• Long Huang, Jiarui Wu, Baorong Lian, Daxue Zhang, Yujia Zhai, and Liming Cao.
• Department of Anesthesiology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China.
• Medicine (Baltimore). 2023 Oct 13; 102 (41): e35467e35467.

RationaleAnesthetic management during resection of pheochromocytoma is a huge challenge, especially when accompanied by dilated cardiomyopathy (DCM). However, there is a lack of research evidence in this area.Patient ConcernsA 36-year-old man was admitted with a left retroperitoneal space-occupying lesion, present for 2 years. The patient also had DCM for 2 years. Blood analysis on admission showed elevated levels of norepinephrine and the N-terminus of the brain natriuretic peptide precursor. Abdominal computed tomography revealed a circular shadow in the left adrenal area. Echocardiography showed a cardiac ejection fraction of 31% to 37%, markedly enlarged left atrium and left ventricle, extensive cardiac hypokinesia, and reduced left ventricular diastolic and systolic functions.DiagnosesThe preoperative diagnosis was left paraganglioma/pheochromocytoma with DCM.InterventionsMultidisciplinary consultation, blood pressure measurements, and volume expansion measurements were performed preoperatively. Invasive arterial blood pressure, central venous pressure, depth of anesthesia, cardiac function, left heart volume, and body temperature were monitored intraoperatively.OutcomesThe adrenal pheochromocytoma was successfully removed, and the patient recovered well.LessonsThe anesthetic management for adrenal pheochromocytoma resection in adult patients with DCM is extremely high-risk but is evidently not impossible. Adequate preoperative evaluation and preparation, optimization of the anesthesia induction plan, close intraoperative monitoring of cardiac function and hemodynamic changes, and robot-assisted laparoscopic technology are the key success factors. The challenges to anesthetic management may be partly prevented with invasive monitoring techniques and minimally invasive surgery. This case confirms the importance of individual management and multidisciplinary cooperation for a successful outcome.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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