Anaesthetic Management of Phaeochromocytoma in an Elderly Patient with Atypical Presentation: An Anaesthetic Dilemma - A Case Report

Background: Phaeochromocytoma accounts for approximately 4% of incidentally discovered adrenal masses, with 9–10% presenting atypically. These atypical presentations pose significant diagnostic and anaesthetic challenges, particularly in elderly patients and may increase the risk of delayed diagnosis and perioperative morbidity. Careful and adequate perioperative preparation has been shown to be an independent determinant of intraoperative haemodynamic stability. The aim of this report is to demonstrate the importance of meticulous preoperative optimization in achieving haemodynamic stability during adrenalectomy for atypical phaeochromocytoma. Case Presentation: We report a 67-year-old woman with a 17-year history of hypertension, well controlled on amlodipine, who was incidentally diagnosed with phaeochromocytoma following an atypical presentation during evaluation for an adrenal mass. Perioperative optimization was achieved using antihypentensive therapy and multidisciplinary planning involving the surgical and anaesthetic teams. She subsequently underwent adrenalectomy under combined general anaesthesia and epidural analgesia. Intraoperative haemodynamics remained stable, including during tumour manipulation and renal vein clamping. The postoperative course was uneventful and she was subsequently discharged in stable condition. Conclusion: Anaesthetic management of phaeochromocytoma remains challenging, particularly in atypical cases where diagnosis may be delayed; however, adequate preoperative optimisation is critical for favourable outcomes. Calcium channel blockers are increasingly relevant in the preoperative preparation of such patients, especially where classical features are absent. This case highlights the importance of thorough perioperative planning in ensuring haemodynamic stability and good surgical outcome.