Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report

Kinge Van Der Heide,Götz Jk Wietasch,Ans Cp Wiesfeld,Ann De Haes,Herman Gd Hendriks

doi:10.1186/1752-1947-5-368

Kinge Van Der Heide, Götz Jk Wietasch + Show 3 more

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https://doi.org/10.1186/1752-1947-5-368

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Abstract

IntroductionTorsades de pointes is a rare but potentially lethal arrhythmia. The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia.Case presentationWe describe the case of a 42-year-old Caucasian woman without QT prolongation preoperatively with recurrent Torsades de pointes during laparoscopic removal of a pheochromocytoma. Torsades de pointes mainly occurs in the setting of a prolonged QT interval. This patient neither had a prolonged QT preoperatively nor was her family history suspect for a congenital long QT syndrome. Most likely, our patient had an acquired long QT syndrome, elicited by the combination of flecainide, hypomagnesemia and adrenergic stimulation during manipulation of the tumor.ConclusionWe show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome. Therefore, preoperative α- and β-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels.

Highlights

Torsades de pointes is a rare but potentially lethal arrhythmia
We show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome
Adrenalectomy for pheochromocytoma has been performed by open lateral retroperitoneal surgery [2]

Summary

Conclusion

A laparoscopic adrenalectomy of a pheochromocytoma in a patient without preoperative QT interval prolongation may result in TdP, most likely elicited by an excess of adrenergic stimulation. Thorough preoperative aand b-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal

Introduction

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