| Anesthetic Management for Bilateral Pheochromocytomas in Multiple Endocrine Neoplasia Type 2a. |
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Hong Sik Lee |
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Department of Anesthesiology, InHa University College of Medicine, Sungnam, Korea. |
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| Abstract |
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Multiple endocrine neoplasis type 2a(MEN 2a) is an inherited syndrome characterized by the occurrence of medullary thyroid carcinoma, parathyroid hyperplasia and adrenal pheochromocytoma. Adrenal Medullary disease varies from hyperplasia to bilateral multiple pheochromocyomas. In anesthetic view, stabillization of severely fluctuating vital signs has become an issue. But fluctutation of vital signs is not always ween especially large pheochromocytoms, and catecholamine releasing activity is higer in right pheochromocytoma than left. It suggests catecholamine releasing activity is affected by the site of pheochromocytoma and size of pheochromocytoma. Surgically, right adrenalectomy is more difficult than left because the vein of right adrenal gland is shorter and larger in diameter than left and it drians into the inferior vena cava directly, but in lfet, it drains into the reneal vein.
Pathologically, nonfunctional of hypofunctional pheochromocytomas which have high ratio of inactivating amines. Another factor is the size of pheochromocytomas.
Lager sized pheochromocytomas frequently has necrotic, hemorrhagic, cystic and myxomatous areas compared to smaller ones. In conclusion, case of bilateral adrenalectomy, more careful anesthetic management is required in right adrenalectomy and in smaller pheochromocytomas. |
| Key Words:
Bilateral pheochromocytomas; Anesthetic management |
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