Prolonged hypoglycemia after the resection of pheochromocytoma in a hemodialysis patient

Abstract

Introduction: Hypoglycemia occasionally develops after the resection of pheochromocytoma due to decreased catecholamine secretion. The unique glucose metabolism in dialysis patients may potentially affect postoperative hypoglycemia, although few reports have focused on this issue.

Case presentation: A 47-year-old woman who had chronic renal failure under hemodialysis was diagnosed with right pheochromocytoma and underwent an adrenalectomy. Three hours after surgery, she experienced symptomatic hypoglycemia, which was repeated until postoperative day 3. Continuous glucose infusion was required until postoperative day 8 and asymptomatic hypoglycemia was repeated until postoperative day 11.

Conclusion: In hemodialysis patients, more careful management of hypoglycemia may be required after the resection of pheochromocytoma compared with non-hemodialysis patients.

Keywords: hemodialysis; hypoglycemia; pheochromocytoma.

Fig. 1

Images of the pheochromocytoma. (a) The right adrenal tumor on T1‐weighted MRI, (b) the right adrenal tumor on T2‐weighted MRI, (c) ¹²³I‐MIBG scintigraphy showing high accumulation in the right adrenal gland.

Fig. 2

Trend of blood glucose level and timing of symptomatic hypoglycemia after surgery. The monitoring consists of blood measurement until POD 2 and capillary measurement after POD 2.