BACKGROUND Pheochromocytoma is well-known for sudden initial presentations, particularly in younger patients. Hemodynamic instability may cause serious complications and delay a patient's ability to undergo surgical resection. Larger tumors present a further challenge because of the risk of catecholamine release during manipulations. In the case we present, increases in systemic vascular resistance caused cardiogenic shock, and the size of the lesion prompted surgeons to veer off from their usual approach. CASE PRESENTATION A 38-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Profound systolic dysfunction (left ventricular ejection fraction of 0.12) was noted together with severely increased systemic vascular resistance, and gradually responded to vasodilator infusion. A left-sided 11-cm adrenal mass was found with computed tomography and confirmed a pheochromocytoma with a meta-iodo-benzyl-guanidine scintigraphy. Surgical treatment was carefully planned by the endocrinologist, anesthesiologist and surgeon, and was ultimately successful. After prolonged hemodynamic stabilization, open adrenalectomy and nephrectomy were deemed safer because of lesion size and the apparent invasion of the kidney. Surgery was successful and the patient was discharged home 5 days after surgery. She is free from disease at almost 2 years from the initial event. CONCLUSIONS Large, invasive pheochromocytoma can be safely and effectively managed with open resection in experienced hands, provided all efforts are made to achieve hemodynamic stabilization and to minimize. Catecholamine release before and during surgery.

中文翻译：

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表现为心源性休克的大型嗜铬细胞瘤的多学科管理：一例报告。

背景技术嗜铬细胞瘤以突然的初始表现而闻名，特别是在年轻患者中。血流动力学不稳定可能会导致严重的并发症并延迟患者进行手术切除的能力。由于操作过程中儿茶酚胺释放的风险，较大的肿瘤提出了进一步的挑战。在我们目前的情况下，全身血管阻力的增加引起心源性休克，病变的大小促使外科医生逐渐偏离他们的常规方法。病例介绍一名38岁的女性患者因高血压和后来的心源性休克被送入我们的重症监护病房。注意到严重的收缩功能障碍（左心室射血分数为0.12）以及严重的全身血管阻力增加，并对输注血管扩张药逐渐作出反应。通过计算机断层扫描发现左侧11 cm肾上腺肿块，并通过间碘-苄基胍胍显像检查证实了嗜铬细胞瘤。内分泌科医生，麻醉师和外科医生精心计划了手术治疗，并最终获得了成功。经过长期的血流动力学稳定后，由于病变大小和明显的肾脏侵犯，开放式肾上腺切除术和肾切除术被认为更安全。手术成功，手术后5天患者已出院。从最初的事件开始，她在大约2年内没有疾病。结论只要尽一切努力实现血流动力学稳定并使其最小化，可以通过经验丰富的双手进行开放式切除术，安全，有效地处理大型浸润性嗜铬细胞瘤。术前和术中释放儿茶酚胺。