Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report

Iheanyi Ihunanya Anokwute; Pride Iguehi Nwokeji; Martina Chioma Odiakosa; Anselm Okwudili Obi

doi:doi:10.11648/j.ijmri.20260202.12

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Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report

Iheanyi Ihunanya Anokwute^*

, Pride Iguehi Nwokeji

, Martina Chioma Odiakosa

, Anselm Okwudili Obi

Published in International Journal of Medical Research and Innovation (Volume 2, Issue 2)

Received: 4 May 2026 Accepted: 15 May 2026 Published: 26 May 2026

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Abstract

Background: Phaeochromocytoma accounts for approximately 4% of incidentally discovered adrenal masses, with 9–10% presenting atypically. These atypical presentations pose significant diagnostic and anaesthetic challenges, particularly in elderly patients and may increase the risk of delayed diagnosis and perioperative morbidity. Careful and adequate perioperative preparation has been shown to be an independent determinant of intraoperative haemodynamic stability. The aim of this report is to demonstrate the importance of meticulous preoperative optimization in achieving haemodynamic stability during adrenalectomy for atypical phaeochromocytoma. Case Presentation: We report a 67-year-old woman with a 17-year history of hypertension, well controlled on amlodipine, who was incidentally diagnosed with phaeochromocytoma following an atypical presentation during evaluation for an adrenal mass. Perioperative optimization was achieved using antihypentensive therapy and multidisciplinary planning involving the surgical and anaesthetic teams. She subsequently underwent adrenalectomy under combined general anaesthesia and epidural analgesia. Intraoperative haemodynamics remained stable, including during tumour manipulation and renal vein clamping. The postoperative course was uneventful and she was subsequently discharged in stable condition. Conclusion: Anaesthetic management of phaeochromocytoma remains challenging, particularly in atypical cases where diagnosis may be delayed; however, adequate preoperative optimisation is critical for favourable outcomes. Calcium channel blockers are increasingly relevant in the preoperative preparation of such patients, especially where classical features are absent. This case highlights the importance of thorough perioperative planning in ensuring haemodynamic stability and good surgical outcome.

Published in	International Journal of Medical Research and Innovation (Volume 2, Issue 2)
DOI	10.11648/j.ijmri.20260202.12
Page(s)	37-40
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Anaesthesia, Phaeochromocytoma, Atypical Presentation, Elderly Patient

References

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[2]	AbuHaweeleh MN, AL-Maslamani AY, AbuAlrob MA, Elsayed A, Altayyan M, Khalil O, Abdulhadi A. Atypical presentation of phaechromocytoma as acute ischaemic stroke and pulmonary embolism, a case report. UroPrecision. 2025; 3: 272–280.
[3]	Saavedra T. JS, Nati-Castillo HA, Valderrama Cometa LA, Rivera-Mart´ınez WA, Asprilla J, Castaño-Giraldo CM, Sa´ nchez S. L, Heredia-Esp´ın M, Arias-Intriago M, Izquierdo-Condoy JS. Pheochromocytoma: an updated scoping review from clinical presentation to management and treatment. Front. Endocrinol. 2024; 15: 1433582. https://doi.org/10.3389/fendo.2024.1433582
[4]	Shah NH, Ruan DT. Pheochromocytoma: a devious opponent in a game of hide-and-seek. Circulation. 2014; 130(15): 1295–8.
[5]	Rupala K, Mittal V, Gupta R, Yadav R. Atypical presentation of pheochromocytoma: Central nervous system pseudovasculitis. Indian J Urol 2017; 33: 82-4. https://doi.org/10.4103/0970-1591.195760
[6]	Gombert AJ, Nerantzinis AM, Li J, Wang W, Yeung IY, Costa A, et al. The perioperative biochemical and clinical considerations of phaechromocytoma management. Int. J. Mol. Sci. 2025; 26(13): 6080. https://doi.org/10.3390/ijms26136080
[7]	Amod KS, Taskeen F, Murthy KTV, Sahajananda H. Anesthetic Management of Pheochromocytoma. J Med Sci. 2019; 5(1): 11–13. https://doi.org/10.5005/jp-journals-10045-00103
[8]	Ramakrishna H. Pheochromocytoma resection: Current concepts in anesthetic management. J Anaesthesiol Clin Pharmacol. 2015; 31(3): 317-23. https://doi.org/10.4103/0970-9185.161665
[9]	Woodrum DT, Kheterpa S. Anaesthetic Management of Phaechromocytoma. World J. Endocr. Surg. 2010; 2(3): 111-117. https://doi.org/10.5005/jp-journals-10002-1034
[10]	Akhtar S, Jones S, Crowley M. Anesthesia for the adult with pheochromocytoma. UpToDate. Retrieved from: www. uptodate.com (Latest update April 2026). 2017.
[11]	Fu S, Wang S, Chen Q, Liu Y, Li Z, Sun T. Laparoscopic versus open surgery for phaechromocytoma: a meta-analysis. BMC Surg. 2020; 20: 167. https://doi.org/10.1186/s12893-020-00824-6
[12]	Goldstein DP, Voigt MR, Ruan D. Current Preoperative Preparation of Pheochromocytoma /Paraganglioma Syndrome. Clin Surg. 2017; 2: 1517.
[13]	Connor D, Boumphrey S. Perioperative care of phaeochromocytoma. BJA Edu. 2016; 16(5): 153–158. https://doi.org/10.1093/bjaed/mkv033
[14]	Sarveshi A, Pandey S. Short Communication Anaesthetic considerations for adrenalectomy: A clinical communication. Southeast Asian J Health Prof. 2025; 8(2): 52-54. https://doi.org/10.18231/j’sajhp.2025.010
[15]	Bhiwal AK, Patidar NC, Vyas AS, Bhokan RR. Anaesthetic challenges in bilateral Phaechromocytoma with history of percutaneous transluminal coronary angioplasty (PTCA): a case report and literature review. Saudi J Anaesth. 2022; 16(2): 240-242. https://doi.org/10.4103/sja.sja76021

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APA Style

Anokwute, I. I., Nwokeji, P. I., Odiakosa, M. C., Obi, A. O. (2026). Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report. International Journal of Medical Research and Innovation, 2(2), 37-40. https://doi.org/10.11648/j.ijmri.20260202.12

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ACS Style

Anokwute, I. I.; Nwokeji, P. I.; Odiakosa, M. C.; Obi, A. O. Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report. Int. J. Med. Res. Innovation 2026, 2(2), 37-40. doi: 10.11648/j.ijmri.20260202.12

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AMA Style

Anokwute II, Nwokeji PI, Odiakosa MC, Obi AO. Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report. Int J Med Res Innovation. 2026;2(2):37-40. doi: 10.11648/j.ijmri.20260202.12

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@article{10.11648/j.ijmri.20260202.12,
  author = {Iheanyi Ihunanya Anokwute and Pride Iguehi Nwokeji and Martina Chioma Odiakosa and Anselm Okwudili Obi},
  title = {Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report},
  journal = {International Journal of Medical Research and Innovation},
  volume = {2},
  number = {2},
  pages = {37-40},
  doi = {10.11648/j.ijmri.20260202.12},
  url = {https://doi.org/10.11648/j.ijmri.20260202.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmri.20260202.12},
  abstract = {Background: Phaeochromocytoma accounts for approximately 4% of incidentally discovered adrenal masses, with 9–10% presenting atypically. These atypical presentations pose significant diagnostic and anaesthetic challenges, particularly in elderly patients and may increase the risk of delayed diagnosis and perioperative morbidity. Careful and adequate perioperative preparation has been shown to be an independent determinant of intraoperative haemodynamic stability. The aim of this report is to demonstrate the importance of meticulous preoperative optimization in achieving haemodynamic stability during adrenalectomy for atypical phaeochromocytoma. Case Presentation: We report a 67-year-old woman with a 17-year history of hypertension, well controlled on amlodipine, who was incidentally diagnosed with phaeochromocytoma following an atypical presentation during evaluation for an adrenal mass. Perioperative optimization was achieved using antihypentensive therapy and multidisciplinary planning involving the surgical and anaesthetic teams. She subsequently underwent adrenalectomy under combined general anaesthesia and epidural analgesia. Intraoperative haemodynamics remained stable, including during tumour manipulation and renal vein clamping. The postoperative course was uneventful and she was subsequently discharged in stable condition. Conclusion: Anaesthetic management of phaeochromocytoma remains challenging, particularly in atypical cases where diagnosis may be delayed; however, adequate preoperative optimisation is critical for favourable outcomes. Calcium channel blockers are increasingly relevant in the preoperative preparation of such patients, especially where classical features are absent. This case highlights the importance of thorough perioperative planning in ensuring haemodynamic stability and good surgical outcome.},
 year = {2026}
}

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TY  - JOUR
T1  - Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report
AU  - Iheanyi Ihunanya Anokwute
AU  - Pride Iguehi Nwokeji
AU  - Martina Chioma Odiakosa
AU  - Anselm Okwudili Obi
Y1  - 2026/05/26
PY  - 2026
N1  - https://doi.org/10.11648/j.ijmri.20260202.12
DO  - 10.11648/j.ijmri.20260202.12
T2  - International Journal of Medical Research and Innovation
JF  - International Journal of Medical Research and Innovation
JO  - International Journal of Medical Research and Innovation
SP  - 37
EP  - 40
PB  - Science Publishing Group
SN  - 3070-6319
UR  - https://doi.org/10.11648/j.ijmri.20260202.12
AB  - Background: Phaeochromocytoma accounts for approximately 4% of incidentally discovered adrenal masses, with 9–10% presenting atypically. These atypical presentations pose significant diagnostic and anaesthetic challenges, particularly in elderly patients and may increase the risk of delayed diagnosis and perioperative morbidity. Careful and adequate perioperative preparation has been shown to be an independent determinant of intraoperative haemodynamic stability. The aim of this report is to demonstrate the importance of meticulous preoperative optimization in achieving haemodynamic stability during adrenalectomy for atypical phaeochromocytoma. Case Presentation: We report a 67-year-old woman with a 17-year history of hypertension, well controlled on amlodipine, who was incidentally diagnosed with phaeochromocytoma following an atypical presentation during evaluation for an adrenal mass. Perioperative optimization was achieved using antihypentensive therapy and multidisciplinary planning involving the surgical and anaesthetic teams. She subsequently underwent adrenalectomy under combined general anaesthesia and epidural analgesia. Intraoperative haemodynamics remained stable, including during tumour manipulation and renal vein clamping. The postoperative course was uneventful and she was subsequently discharged in stable condition. Conclusion: Anaesthetic management of phaeochromocytoma remains challenging, particularly in atypical cases where diagnosis may be delayed; however, adequate preoperative optimisation is critical for favourable outcomes. Calcium channel blockers are increasingly relevant in the preoperative preparation of such patients, especially where classical features are absent. This case highlights the importance of thorough perioperative planning in ensuring haemodynamic stability and good surgical outcome.
VL  - 2
IS  - 2
ER  -

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Author Information

Iheanyi Ihunanya Anokwute

Anaesthesia Department, National Orthopaedic Hospital, Enugu, Nigeria

Contact Email

http://orcid.org/0009-0003-0921-0303
Pride Iguehi Nwokeji

Anaesthesia Department, National Orthopaedic Hospital, Enugu, Nigeria

Contact Email

http://orcid.org/0009-0005-9555-4587
Martina Chioma Odiakosa

Anaesthesia Department, National Orthopaedic Hospital, Enugu, Nigeria

Contact Email

http://orcid.org/0009-0009-1705-6098
Anselm Okwudili Obi

Urology Department, Alex Ekwueme University Teaching Hospital, Abakaliki, Nigeria

Contact Email

http://orcid.org/0000-0003-2733-6455

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APA Style

Anokwute, I. I., Nwokeji, P. I., Odiakosa, M. C., Obi, A. O. (2026). Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report. International Journal of Medical Research and Innovation, 2(2), 37-40. https://doi.org/10.11648/j.ijmri.20260202.12

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ACS Style

Anokwute, I. I.; Nwokeji, P. I.; Odiakosa, M. C.; Obi, A. O. Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report. Int. J. Med. Res. Innovation 2026, 2(2), 37-40. doi: 10.11648/j.ijmri.20260202.12

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AMA Style

Anokwute II, Nwokeji PI, Odiakosa MC, Obi AO. Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report. Int J Med Res Innovation. 2026;2(2):37-40. doi: 10.11648/j.ijmri.20260202.12

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@article{10.11648/j.ijmri.20260202.12,
  author = {Iheanyi Ihunanya Anokwute and Pride Iguehi Nwokeji and Martina Chioma Odiakosa and Anselm Okwudili Obi},
  title = {Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report},
  journal = {International Journal of Medical Research and Innovation},
  volume = {2},
  number = {2},
  pages = {37-40},
  doi = {10.11648/j.ijmri.20260202.12},
  url = {https://doi.org/10.11648/j.ijmri.20260202.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmri.20260202.12},
  abstract = {Background: Phaeochromocytoma accounts for approximately 4% of incidentally discovered adrenal masses, with 9–10% presenting atypically. These atypical presentations pose significant diagnostic and anaesthetic challenges, particularly in elderly patients and may increase the risk of delayed diagnosis and perioperative morbidity. Careful and adequate perioperative preparation has been shown to be an independent determinant of intraoperative haemodynamic stability. The aim of this report is to demonstrate the importance of meticulous preoperative optimization in achieving haemodynamic stability during adrenalectomy for atypical phaeochromocytoma. Case Presentation: We report a 67-year-old woman with a 17-year history of hypertension, well controlled on amlodipine, who was incidentally diagnosed with phaeochromocytoma following an atypical presentation during evaluation for an adrenal mass. Perioperative optimization was achieved using antihypentensive therapy and multidisciplinary planning involving the surgical and anaesthetic teams. She subsequently underwent adrenalectomy under combined general anaesthesia and epidural analgesia. Intraoperative haemodynamics remained stable, including during tumour manipulation and renal vein clamping. The postoperative course was uneventful and she was subsequently discharged in stable condition. Conclusion: Anaesthetic management of phaeochromocytoma remains challenging, particularly in atypical cases where diagnosis may be delayed; however, adequate preoperative optimisation is critical for favourable outcomes. Calcium channel blockers are increasingly relevant in the preoperative preparation of such patients, especially where classical features are absent. This case highlights the importance of thorough perioperative planning in ensuring haemodynamic stability and good surgical outcome.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report
AU  - Iheanyi Ihunanya Anokwute
AU  - Pride Iguehi Nwokeji
AU  - Martina Chioma Odiakosa
AU  - Anselm Okwudili Obi
Y1  - 2026/05/26
PY  - 2026
N1  - https://doi.org/10.11648/j.ijmri.20260202.12
DO  - 10.11648/j.ijmri.20260202.12
T2  - International Journal of Medical Research and Innovation
JF  - International Journal of Medical Research and Innovation
JO  - International Journal of Medical Research and Innovation
SP  - 37
EP  - 40
PB  - Science Publishing Group
SN  - 3070-6319
UR  - https://doi.org/10.11648/j.ijmri.20260202.12
AB  - Background: Phaeochromocytoma accounts for approximately 4% of incidentally discovered adrenal masses, with 9–10% presenting atypically. These atypical presentations pose significant diagnostic and anaesthetic challenges, particularly in elderly patients and may increase the risk of delayed diagnosis and perioperative morbidity. Careful and adequate perioperative preparation has been shown to be an independent determinant of intraoperative haemodynamic stability. The aim of this report is to demonstrate the importance of meticulous preoperative optimization in achieving haemodynamic stability during adrenalectomy for atypical phaeochromocytoma. Case Presentation: We report a 67-year-old woman with a 17-year history of hypertension, well controlled on amlodipine, who was incidentally diagnosed with phaeochromocytoma following an atypical presentation during evaluation for an adrenal mass. Perioperative optimization was achieved using antihypentensive therapy and multidisciplinary planning involving the surgical and anaesthetic teams. She subsequently underwent adrenalectomy under combined general anaesthesia and epidural analgesia. Intraoperative haemodynamics remained stable, including during tumour manipulation and renal vein clamping. The postoperative course was uneventful and she was subsequently discharged in stable condition. Conclusion: Anaesthetic management of phaeochromocytoma remains challenging, particularly in atypical cases where diagnosis may be delayed; however, adequate preoperative optimisation is critical for favourable outcomes. Calcium channel blockers are increasingly relevant in the preoperative preparation of such patients, especially where classical features are absent. This case highlights the importance of thorough perioperative planning in ensuring haemodynamic stability and good surgical outcome.
VL  - 2
IS  - 2
ER  -

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