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A Surgical Emergency

Kenneth A. Newell, MD; Richard A. Prinz, MD; Jack Pickleman, MD; Susan Braithwaite, MD; Marion Brooks, MD; Tom H. Karson, MD; Silas Glisson, PhD

Arch Surg. 1988;123(8):956-959.

Abstract
• Three of 27 patients treated for pheochromocytoma between 1974 and 1987 presented with pheochromocytoma multisystem crisis (PMC). This unusual presentation consists of multiple organ system failure, temperature often greater than 40°C, encephalopathy, and hypertension and/or hypotension. Although urgent medical therapy achieved blood pressure control in all three patients, the other manifestations of PMC progressed rapidly in spite of alpha and even beta blockade. The first patient died during attempts to localize a septic focus. The other two patients underwent urgent adrenalectomy and had postoperative improvement in their multiple organ system failure. All three tumors were large and produced markedly elevated levels of epinephrine. In conclusion (1) PMC is an unusual presentation of pheochromocytoma; (2) its manifestations include multiple organ system failure, high fever, encephalopathy, and vascular lability; (3) it may result from increased epinephrine secretion; and (4) successful treatment of PMC demands prompt diagnosis, vigorous medical preparation, and emergency tumor removal if the patient's condition continues to deteriorate.

(Arch Surg 1988;123:956-959)

Author Affiliations
From the Department of Surgery (Drs Newell, Prinz, and Pickleman), Medicine (Drs Braithwaite, Brooks, and Karson), and Anesthesia (Dr Glisson), Loyola University, Maywood, Ill.

Footnotes
Accepted for publication April 8, 1988.

Read before the 95th Annual Meeting of the Western Surgical Association, Dallas, Nov 17, 1987.

Reprint requests to the Department of Surgery, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153 (Dr Prinz).

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