Magnesium Infusion for Refractory Non-surgical Pheochromocytoma Crisis
Pheochromocytoma crisis is a rare medical emergency characterized by severe hypertension, shock, and multiorgan failure. Despite its widespread availability, low cost and wide therapeutic index, magnesium sulfate has primarily been utilized as an adrenergic antagonist during pheochromocytoma resection. This case report describes a 57-year-old male with recurrent nonsurgical pheochromocytoma and crisis refractory to adrenergic antagonism. Initiation of magnesium sulfate continuous infusion provided rapid hemodynamic control in the setting of inoperable disease. This case highlights the role and dosing of magnesium sulfate in the management of pheochromocytoma crisis.
O'Riordan JA. Pheochromocytomas and anesthesia. Int Anesthesiol Clin 1997;35:99-127.
Herroeder S, Schönherr ME, De Hert SG, Hollmann MW. Magnesium: essentials for anesthesiologists. Anesthesiology 2011;114:971-993.
James MF, Cronjé L. Pheochromocytoma crisis: the use of magnesium sulfate. Anesth Analg 2004;99:680-686.
Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003;50:732-746.
Domi R, Laho H. Management of pheochromocytoma: old ideas and new drugs. Niger J Clin Pract 2012;15:253-257.
Lord MS, Augoustides JG. Perioperative management of pheochromocytoma: focus on magnesium, clevidipine, and vasopressin. J Cardiothorac Vasc Anesth 2012;26:526-531.
Werbel SS, Ober KP. Pheochromocytoma: update on diagnosis, localization, and management. Med Clin North Am 1995;79:131-153.
Kizer JR, Koniaris LS, Edelman JD, St John Sutton MG. Pheochromocytoma crisis, cardiomyopathy, and hemodynamic collapse. Chest 2000;118:1221-1223.
Bergland BE. Pheochromocytoma presenting as shock. Am J Emerg Med 1989;7:44–48.
Shah MH, Goldner WS, Halfdanarson TR, Bergsland E, Berlin JD, et al. NCCN guidelines insights: neuroendocrine and adrenal tumors version 2.2018. J Natl Compr Canc Netw 2018;16:693-702.
James MF. Use of magnesium sulphate in the anaesthetic management of pheochromocytoma: a review of 17 anaesthetics. Br J Anaesth 1989;62:6161-6123.
Minami T, Adachi T, Fukuda K. An effective use of magnesium sulfate for intraoperative management of laparoscopic adrenalectomy for pheochromocytoma in a pediatric patient. Anesth Analg 2002;95:1243-1244.