INVASIVE ADRENAL PHEOCHROMOCYTOMA IN A CHILD REQUIRING TOTAL NEPHRECTOMY: ANAESTHETIC CHALLENGES

Pheochromocytoma is a rare catecholamine-secreting neuroendocrine tumor in children and is associated with major perioperative anaesthetic risk. We report a pediatric case of invasive adrenal pheochromocytoma associated with ipsilateral renal artery occlusion and requiring adrenalectomy with total nephrectomy. The patient was a 13- year-old girl referred for surgical management of a large hypervascular adrenal mass closely related to the abdominal aorta. Preoperative management included alpha-adrenergic blockade and volume optimization before surgery. General anaesthesia was performed with invasive arterial pressure monitoring, central venous access, careful titration of induction, and thoraco-lumbar epidural analgesia placed before induction under full monitoring. Tumor manipulation was associated with major blood pressure variability requiring nicardipine. After tumor devascularization and removal, hypotension required norepinephrine support. Surgical dissection was complicated by major bleeding and haemorrhagic shock, treated with rapid transfusion and fibrinogen supplementation for acquired coagulopathy. Because of vascular involvement and renal artery occlusion, complete resection required adrenalectomy associated with total nephrectomy. The patient was transferred to the intensive care unit, stabilized, extubated safely, and subsequently transferred back to the referring ward without early major postoperative complications. This case highlights the need for multidisciplinary planning, preoperative adrenergic blockade, invasive monitoring, anticipation of both hypertensive and hypotensive crises, and preparedness for massive bleeding during pediatric pheochromocytoma surgery