Case Report

Rhabdomyolysis and Acute Myoglobinuric Renal Failure in a Patient With Bilateral Pheochromocytoma Following Open Pyelolithotomy

Authors: Inan Anaforoglu, MD, M Eda Ertorer, MD, Filiz E. Haydardedeoglu, MD, Tamer Colakoglu, MD, Naime Tokmak, MD, Nilgun G. Demirag, MD

Abstract

Rhabdomyolysis is an unusual manifestation of pheochromocytoma. Early diagnosis and prompt management are crucial, as it may have life-threatening consequences. This is the case of a 19-year-old man with bilateral pheochromocytoma complicated with rhabdomyolysis and acute myoglobinuric renal failure after surgery for nephrolithiasis. A massive catecholamine release during the procedure manifested itself as a hypertensive crisis, producing severe vasoconstriction and thereby provoking ischemia of the patient's muscle tissue. This insult resulted in rhabdomyolysis and acute myoglobinuric renal failure. After making sure that all necessary medical precautions were performed, including blood pressure stabilization with alpha receptor blockade and adequate fluid replacement, the patient successfully underwent a bilateral cortex-sparing medullar adrenalectomy. The operation specimen was reported as pheochromocytoma.


Key Points


* Rhabdomyolysis is a rare complication of pheochromocytoma.


* It is thought to be caused by catecholamine-mediated vasoconstriction and skeletal muscle ischemia during a hypertensive crisis.


* Rhabdomyolysis may result in acute myoglobinuric renal failure.

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