Undiagnosed Retroperitoneal Paraganglioma, an Anaesthesiologist’s Challenge

Majority of the phaeochromocytomas are seen in the adrenal medulla, with a few being extra-adrenal. We present a case of a forty-seven year old hypertensive man who was taken up for a retroperitoneal tumour excision. On manipulation of the tumour there was severe rise in blood pressure and heart rate along with ST-T changes on the electrocardiogram, which suggested the possibility of a catecholamine producing tumour. Haemodynamics were controlled effectively with antihypertensive drugs, and the tumour was removed, after which the patient required inotropic support to control hypotension. Histopathology confirmed the presence of paraganglioma. A patient with a retroperitoneal tumour should be suspected of having a paraganglioma, even in an asymptomatic case. Management of such cases poses a challenge to the anaesthesiologist, even with the advent of new drugs.