Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report
Abstract Background Surgical treatment of pheochromocytomas is associated with circulatory dynamics instability, necessitating systemic management of the patient in the intensive care unit after surgery. Early mobilization after pheochromocytoma surgery is not described in the guidelines, and to our...
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BMC
2024-10-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-024-04833-4 |
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| author | Kenichi Fudeyasu Satoshi Kamiya Shunsuke Taito Yuki Nakashima Makoto Asaeda Takahiro Kato Yukari Toyota Hiroyuki Kitano Nobuyuki Hinata Haruya Ohno Yukio Mikami |
| author_facet | Kenichi Fudeyasu Satoshi Kamiya Shunsuke Taito Yuki Nakashima Makoto Asaeda Takahiro Kato Yukari Toyota Hiroyuki Kitano Nobuyuki Hinata Haruya Ohno Yukio Mikami |
| author_sort | Kenichi Fudeyasu |
| collection | DOAJ |
| description | Abstract Background Surgical treatment of pheochromocytomas is associated with circulatory dynamics instability, necessitating systemic management of the patient in the intensive care unit after surgery. Early mobilization after pheochromocytoma surgery is not described in the guidelines, and to our knowledge, no reports have specifically focused on circulatory dynamics during early mobilization after surgery. Case presentation A 31-year-old Japanese woman was diagnosed with bilateral pheochromocytoma and underwent a second-stage adrenalectomy for bilateral pheochromocytoma at our hospital. We evaluated circulatory dynamics during a passive upright posture on postoperative days 1 and 4. She was placed on a tilt bed in the supine position (0° head) for 15 min, passive upright posture (60°) for 15 min, and supine position again for 10 min. In the passive upright posture, both systolic and diastolic blood pressure decreased, and the heart rate increased by 10 bpm over approximately 10 minutes. After the postural change from the passive upright posture to the supine position, the heart rate decreased to a level lower than in the supine prior to the passive upright posture. The same measurements were taken on postoperative day 4. Systolic blood pressure decreased in the passive upright posture, but diastolic blood pressure remained unchanged. The heart rate also increased earlier after passive upright posture compared with that on the day after surgery. When the patient returned to the supine position from the passive upright posture, the heart rate decreased even further compared with its level prior to the passive upright posture, as observed on the day after surgery. Conclusion Circulatory dynamics may fluctuate after surgery for pheochromocytoma due to a relative decrease in epinephrine and norepinephrine secretion. In this case, the patient’s response may be close to normal by the fourth postoperative day, but circulatory dynamics fluctuations were noted on both the first and fourth postoperative days when the patient was supine after passive upright posture. Although the substantial variability of perioperative circulatory dynamics in patients with pheochromocytoma has improved considerably with the development of perioperative management guidelines, circulatory dynamics should be carefully monitored during early mobilization and after its completion. |
| format | Article |
| id | doaj-art-1c00f0796e724e0a9996f6defe4a189d |
| institution | OA Journals |
| issn | 1752-1947 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
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| series | Journal of Medical Case Reports |
| spelling | doaj-art-1c00f0796e724e0a9996f6defe4a189d2025-08-20T02:18:33ZengBMCJournal of Medical Case Reports1752-19472024-10-011811910.1186/s13256-024-04833-4Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case reportKenichi Fudeyasu0Satoshi Kamiya1Shunsuke Taito2Yuki Nakashima3Makoto Asaeda4Takahiro Kato5Yukari Toyota6Hiroyuki Kitano7Nobuyuki Hinata8Haruya Ohno9Yukio Mikami10Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University HospitalDepartment of Anesthesiology and Critical Care, Hiroshima UniversityDivision of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University HospitalDivision of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University HospitalDivision of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University HospitalDepartment of Anesthesiology and Critical Care, Hiroshima UniversityDepartment of Anesthesiology and Critical Care, Hiroshima UniversityDepartment of Urology, Hiroshima University HospitalDepartment of Urology, Hiroshima University HospitalEndocrinology and Diabetic Medicine, Hiroshima University HospitalDepartment of Rehabilitation Medicine, Hiroshima University HospitalAbstract Background Surgical treatment of pheochromocytomas is associated with circulatory dynamics instability, necessitating systemic management of the patient in the intensive care unit after surgery. Early mobilization after pheochromocytoma surgery is not described in the guidelines, and to our knowledge, no reports have specifically focused on circulatory dynamics during early mobilization after surgery. Case presentation A 31-year-old Japanese woman was diagnosed with bilateral pheochromocytoma and underwent a second-stage adrenalectomy for bilateral pheochromocytoma at our hospital. We evaluated circulatory dynamics during a passive upright posture on postoperative days 1 and 4. She was placed on a tilt bed in the supine position (0° head) for 15 min, passive upright posture (60°) for 15 min, and supine position again for 10 min. In the passive upright posture, both systolic and diastolic blood pressure decreased, and the heart rate increased by 10 bpm over approximately 10 minutes. After the postural change from the passive upright posture to the supine position, the heart rate decreased to a level lower than in the supine prior to the passive upright posture. The same measurements were taken on postoperative day 4. Systolic blood pressure decreased in the passive upright posture, but diastolic blood pressure remained unchanged. The heart rate also increased earlier after passive upright posture compared with that on the day after surgery. When the patient returned to the supine position from the passive upright posture, the heart rate decreased even further compared with its level prior to the passive upright posture, as observed on the day after surgery. Conclusion Circulatory dynamics may fluctuate after surgery for pheochromocytoma due to a relative decrease in epinephrine and norepinephrine secretion. In this case, the patient’s response may be close to normal by the fourth postoperative day, but circulatory dynamics fluctuations were noted on both the first and fourth postoperative days when the patient was supine after passive upright posture. Although the substantial variability of perioperative circulatory dynamics in patients with pheochromocytoma has improved considerably with the development of perioperative management guidelines, circulatory dynamics should be carefully monitored during early mobilization and after its completion.https://doi.org/10.1186/s13256-024-04833-4Circulatory dynamicsPassive upright posturePerioperative periodPheochromocytomaCase report |
| spellingShingle | Kenichi Fudeyasu Satoshi Kamiya Shunsuke Taito Yuki Nakashima Makoto Asaeda Takahiro Kato Yukari Toyota Hiroyuki Kitano Nobuyuki Hinata Haruya Ohno Yukio Mikami Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report Journal of Medical Case Reports Circulatory dynamics Passive upright posture Perioperative period Pheochromocytoma Case report |
| title | Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report |
| title_full | Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report |
| title_fullStr | Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report |
| title_full_unstemmed | Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report |
| title_short | Circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma: a case report |
| title_sort | circulatory characteristics of early mobilization after surgery for bilateral pheochromocytoma a case report |
| topic | Circulatory dynamics Passive upright posture Perioperative period Pheochromocytoma Case report |
| url | https://doi.org/10.1186/s13256-024-04833-4 |
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