Anesthesia for surgical removal of pheochromocytoma in a child with diabetes insipidus

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We report anesthesia for pheochromocytoma resection in a 15-year-old boy. He had panhypopituitarism due to surgical removal of primitive neuroectodermal tumor in the brain and postoperative chemotherapy at 9 months of age, and has been receiving desmopressin for diabetes insipidus. A diagnosis of pheochromocytoma was made based on an elevated urinary excretion of catecholamines and their metabolites as well as a mass lesion in the adrenal gland detected by computed tomography, and surgical removal was scheduled. Preoperatively blood pressure was controlled by doxazocine, an α₁-adenoreceptor antagonist and desmopressin was replaced with continuous infusion of vasopressin, which was continued during anesthesia. Total intravenous anesthesia with propofol, fentanyl and remifentanil was performed. Besides increasing the dose of remifentanil, phentolamine, nicardipine and landiolol were administered for controlling hypertension and tachycardia in response to surgical stimuli. Hypotension after adrenalectomy was restored by noradrenaline and by increasing the infusion rate of vasopressin. Surgery completed uneventfully, urine output was remained constant during anesthesia.