Intraoperative hypertensive crisis due to a catecholamine-secreting esthesioneuroblastoma

Vafi Salmasi, Adam Schiavi, Zev A. Binder, Jacob Ruzevick, Brent A. Orr, Peter C. Burger, Douglas W Ball, Ari M Blitz, Wayne Martin Koch, Masaru Ishii, Gary L Gallia

Research output: Contribution to journalArticle

Abstract

Background Although uncommon, esthesioneuroblastomas may produce clinically significant amounts of catecholamines. Methods We report a patient with a catecholamine-secreting esthesioneuroblastoma who developed an intraoperative hypertensive crisis. Results A patient with a history of hypertension was referred to our skull base center for management of a residual esthesioneuroblastoma. A staged endonasal endoscopic approach was planned. At the conclusion of the first stage, a hypertensive crisis occurred. Workup revealed elevated levels of serum and urinary catecholamines. The patient was treated with alpha adrenoceptor blockade before the second stage. Serum catecholamine levels after this second stage were normal. On immunohistochemical analysis, the tumor cells were found to be positive for tyrosine hydroxylase, the rate limiting enzyme in catecholamine synthesis, and achaete-scute homologue 1, a transcription factor essential in the development of olfactory and sympathetic neurons. Conclusion Catecholamine production should be considered in the differential of unexpected extreme hypertension during surgical resection of esthesioneuroblastoma.

Original languageEnglish (US)
Pages (from-to)E74-E80
JournalHead and Neck
Volume37
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Olfactory Esthesioneuroblastoma
Catecholamines
Hypertension
Skull Base
Tyrosine 3-Monooxygenase
Serum
Adrenergic Receptors
Transcription Factors
Neurons
Enzymes

Keywords

  • catecholamine
  • esthesioneuroblastoma
  • expanded endonasal endoscopic approach
  • hypertensive crisis
  • tyrosine hydroxylase

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Intraoperative hypertensive crisis due to a catecholamine-secreting esthesioneuroblastoma. / Salmasi, Vafi; Schiavi, Adam; Binder, Zev A.; Ruzevick, Jacob; Orr, Brent A.; Burger, Peter C.; Ball, Douglas W; Blitz, Ari M; Koch, Wayne Martin; Ishii, Masaru; Gallia, Gary L.

In: Head and Neck, Vol. 37, No. 6, 01.06.2015, p. E74-E80.

Research output: Contribution to journalArticle

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