Pheochromocytoma: Shock Following Resection

Abstract

To the Editor:— It is unfortunate that in the article entitled Pheochromocytoma: Shock Following Surgery by Hardy and others ( JAMA 179 :107 [Jan. 13] 1962) no ketosteroid studies were recorded, nor was corticosterone included in the measures employed to combat the prolonged postoperative hypotension. In a similar case, 1 of 2 reported inThe Journalof Sept. 19, 1959, urinary 17-ketosteroid excretion was found to be less than 1 mg. in 24 hours. Postoperative shock in this patient responded promptly to intravenous administration of hydrocortisone. In at least one other series reported in the literture, ketosteroid excretion was found to be abnormally low in a high proportion of patients with pheochromocytoma. It seems not unreasonable to postulate that the prolonged stimulation by the enormous amounts of epinephrine and norepinephrine elaborated by the tumor may result in exhaustion or depression, or both, of the adrenal cortex as well as the medulla,