Abstract
A patient with a longstanding history of mild hypertension undergoing elective coronary artery bypass grafting exhibited extreme and paroxysmal elevations of systemic blood pressure immediately after separation from cardioputmonary bypass. Conventional antihypertensive therapy (nitroprusside, hydralazine, propranolol) was ineffective, whereas phentolamine infusion produced a decrease in systemic blood pressure. These observations led to the discovery of a predominantly norepinephrine-secreting phaeochromocytoma. This case is noteworthy in that cardiopulmonary bypass may have served as a stimulus for tumour secretion of catecholamine. Possible mechanisms for this effect are discussed.
Résumé
Un patient présentant une histoire d’hypertension modérée chronique devant subir un pontage aortocoro-narien électif a présenté des élévations extrêmes de la tension artérielle immédiatement après la cessation de la CEC. Le traitement antihypertenseur conventionnel (nitroprussiate, hydralasine, propranolol) était inefficace, alors que la phentolamine en perfusion a produit une diminution de la tension artérielle systémique. Ces observations ont conduit à ta découverte d’un phéo-chromocytome sécrétant la norépinephrine. Ce cas est intéressant car la CEC peut avoir déclenché la sécrétion de catécholamine par la tumeur. Les mécanismes pos-sibles de cet effet sont discutés.
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Brown, P., Caplan, R.A. Recognition of an unsuspected phaeochromocytoma during elective coronary artery bypass surgery. Can Anaesth Soc J 33, 785–789 (1986). https://doi.org/10.1007/BF03027131
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DOI: https://doi.org/10.1007/BF03027131