A man in his mid-forties, Mr. Ravindra, who hails from Vijayawada, Andhra Pradesh, was struggling with a long-standing history of hypertension. With systolic readings above 200 mmHg and diastolic readings above 100 mmHg for several years, his blood pressure remained continuously high. Despite consulting multiple physicians and cardiologists and being prescribed three to four anti-hypertensive medications, his blood pressure was never adequately controlled.
After dealing with persistent health issues, he later consulted Dr. Sachin Marda, Clinical Director & Senior Consultant Oncologist & Robotic Surgeon (Cancer Specialist) Yashoda Hospitals – Somajiguda Unit, Hyderabad, as a ray of hope for proper medical guidance. A well-trained team of medical professionals at the hospital examined him thoroughly and traced some subtle red flags that pointed toward a secondary cause of hypertension. Strange but true, those red flags included sudden spikes in blood pressure, often accompanied by headaches, palpitations, sweating, and occasional blurring of vision. His blood pressure fluctuated between very high and sometimes lower readings. Not only did he have fluctuating hypertension, but he also had resistant hypertension, which means it remained uncontrolled even with medications. Symptoms such as anxiety, panic episodes, and unexplained tachycardia (abnormally fast heart rate, even at rest) were also present. All these signs, especially in a relatively young person, raised the possibility of an underlying endocrine cause like pheochromocytoma—a rare tumor that grows in the adrenal gland.
Due to complications from long-standing hypertension, the patient had also undergone bypass surgery six months before visiting the hospital. However, his blood pressure remained uncontrolled even after the surgery. At Yashoda Hospitals, Hyderabad, investigations including MRI, PET scan, tumor markers, and urinary studies revealed markedly elevated catecholamine levels.
A tumor in the left adrenal gland, identified as pheochromocytoma, was confirmed after further imaging. This rare condition is found in less than one percent of all hypertension patients but is slightly more common in those with resistant hypertension. The tumor was secreting excessive adrenaline and catecholamines (a group of hormones that regulate stress, increase heart rate, blood pressure, and alertness). This finding explained his severe, fluctuating, and resistant blood pressure.
In this case, a robotic adrenalectomy which is a minimally invasive keyhole procedure, was planned. Preoperative preparation was critical. The patient was started on alpha blockers followed by beta blockers to stabilize blood pressure. Cardiac function was optimized with detailed evaluation and cardiology support.
The surgery itself required a highly experienced anesthesia team. During tumor handling, there can be sudden surges of catecholamines causing dangerously high blood pressure. Once the tumor is removed, hormone levels drop rapidly, which can lead to sudden hypotension. Managing these fluctuations requires precise intraoperative monitoring and expertise.
The robotic approach offered several advantages in this complex case. It provided exact precision, better 3D visualization, minimal blood loss, and reduced tumor manipulation. This helped limit hormone surges during surgery. The patient also benefited from a shorter hospital stay and faster recovery.
Pheochromocytoma is a rare but potentially life-threatening cause of hypertension if not diagnosed in time. Early recognition of warning signs such as resistant or fluctuating blood pressure, along with symptoms like palpitations and sweating, is essential. With timely diagnosis, careful preoperative preparation, and a coordinated multidisciplinary approach, surgical outcomes improve significantly. In many patients, blood pressure can return to normal after tumor removal, improving long-term health and quality of life.
The surgery was successful, and by the fifth day, his blood pressure had normalized. He was able to return to his routine life soon after. In many such cases, hypertension becomes reversible after tumor removal, with studies showing normalization in a significant proportion of patients, although outcomes may vary depending on other health conditions.
Such a rare diagnosis, if unidentified, missed, or delayed, could be dangerous. Serious complications such as stroke, heart attack, or even aortic dissection can occur in patients with a hypertensive crisis. Excessive secretion of catecholamines over a long period of time can also weaken the heart muscle, leading to cardiomyopathy (heart muscle disease) and multi-organ damage.
In such cases, routine screening is not recommended for all hypertensive patients due to the rarity of the condition. However, targeted screening is essential in patients with resistant hypertension, suggestive symptoms, adrenal incidentalomas, or certain genetic syndromes. Tests such as 24-hour urinary metanephrines help in confirming the diagnosis.
Cases like this highlight the importance of identifying rare but treatable causes of hypertension. Diagnosing and managing such conditions not only improves patient outcomes but also reinforces the value of careful clinical evaluation.
Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.