ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0124

Renal Replacement Therapy in Pheochromocytoma

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Griffiths, Jennifer, Westchester Medical Center, Valhalla, New York, United States
  • Me, Hay Me, Westchester Medical Center, Valhalla, New York, United States
  • Kapoor, Aromma, Westchester Medical Center, Valhalla, New York, United States
Introduction

Pheochromocytoma is a rare tumor derived from chromaffin cells of the sympathetic nervous system. The triad of headache, palpitations and diaphoresis is often present, but catecholamine excess can present in various contexts. Tumors secreting epinephrine can present with episodic hypotension; rapid cycling fluctuations of hypotension and hypertension also occur.
Most acute kidney injury (AKI) in the setting of pheochromocytoma crisis is due to ischemic acute tubular necrosis (ATN).
For cases requiring renal replacement therapy, there are no studies supporting one form over another.
We describe a patient with Pheochromocytoma who developed AKI requiring renal replacement therapy (RRT).

Case Description

29 year old woman with history of migraines presented to outside hospital with headache and chest pain, and found to be in hypertensive emergency with mild elevation of troponins. Patient was transferred to our hospital for evaluation of possible myocardial infarction.
Cardiac catheterization showed clear coronaries. Patient became hypotensive during the procedure and Intra-Aortic Balloon Pump was placed. Imaging showed high density mass in the left adrenal gland. Patient was started on Phenoxybenzamine. Biochemical tests confirmed Pheochromocytoma.
Labs showed creatinine of 5.38. Patient became anuric and RRT was initiated with intermittent hemodialysis(iHD). On the third dialysis session, patient had wide blood pressure fluctuations and became hypotensive with decreased responsiveness.
Imaging was negative for acute bleed but concerning for cerebral edema.
RRT was switched to continuous renal replacement therapy(CRRT) which was better tolerated.

Discussion

Our patient experienced an acute hypertensive crisis followed by cardiovascular collapse likely precipitated by intravenous glucocorticoids given for presumed myocarditis. Glucocorticoids increase catecholamines ; the excess causes cardiotoxicity which in turn leads to ischemic ATN.
Patient was able to tolerate iHD initially. However, as the Phenoxybenzamine was up titrated, the fluctuations included hypotensive episodes and was worsened on dialysis.
Given the unpredictable fluctuations in blood pressure and the possibility of associated hypertensive encephalopathy and/or cerebral edema in the setting of Pheochromocytoma, it may be prudent to choose CRRT when RRT is warranted, though there are no guidelines regarding which modality is superior in these patients.