Pune, Mar 07: DPU Super Specialty Hospital, Pimpri, Pune, successfully managed a rare and complex case of bilateral pheochromocytoma in a 28-year-old female patient through a coordinated multidisciplinary approach involving endocrinology, urology, laparoscopic surgery, anesthesia and critical care teams.
The patient initially presented with hypertension and diabetes and was undergoing treatment at the endocrinology OPD. During evaluation, a strong familial pattern of diabetes was identified, prompting genetic analysis, which revealed the presence of a Von Hippel-Lindau (VHL) gene mutation. This rare genetic condition is associated with the development of multiple tumours, including pheochromocytomas—adrenal gland tumours that produce excess catecholamines and lead to severe blood pressure fluctuations.
Further investigations, including blood tests and MRI, confirmed bilateral pheochromocytoma, a rare and clinically challenging condition. The case was managed by a multidisciplinary team comprising Dr. Anil Menon, Professor and Head, Department of Endocrinology; Dr. Sunil Mhaske, Urologist; Dr. Rahul V. Shabadi, Anesthesiologist; and Dr. Manoj Dongare, Senior Consultant Surgical Oncology HPB Surgery at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune.
Under the supervision of Dr. Anil Menon, the patient underwent 4–6 weeks of intensive pre-operative optimization, including strict blood pressure control and glycemic stabilization. This phase was critical, as adequate preparation significantly reduces intraoperative and postoperative risks in hormonally active tumours such as pheochromocytoma.
Considering the bilateral nature of the tumours, the surgical team led by Dr. Sunil Mhaske opted for a single-stage bilateral adrenalectomy using a minimally invasive laparoscopic approach. The tumor on the right side measured 5 x 4 cm, while the left measured 4 x 3 cm. The surgery was completed in approximately 3 hours with minimal blood loss of around 100 ml.
The procedure was technically demanding due to the involvement of both adrenal glands and proximity to major vascular structures, including the inferior vena cava (IVC). Despite these challenges, the surgical team successfully removed both tumours in a single sitting without complications.
From an anesthesia perspective, the surgery required highly controlled intraoperative management due to the risk of sudden and severe fluctuations in blood pressure and heart rate which might affect the heart and brain. Operating on both sides for this kind of rare tumor, in the same surgery and that too laparoscopically, was a major challenge for the anesthesia team. Under the supervision of Dr. Rahul V. Shabadi, intraoperative major hemodynamic variations were efficiently managed through continuous monitoring and active, skillful interventions.
The patient had a smooth and uneventful recovery and histopathological examination confirmed pheochromocytoma with no evidence of malignancy. Following the removal of both adrenal glands, the patient has been initiated on lifelong corticosteroid replacement therapy and is currently stable. Notably, the patient does not require medication for diabetes control at present.
Given the underlying genetic condition, the patient will remain under long-term follow-up to monitor for recurrence and manage hormonal balance. This case highlights the importance of early genetic diagnosis, meticulous pre-operative preparation and a multidisciplinary approach in managing rare and high-risk endocrine disorders.
Dr. Bhagyashree P. Patil, Pro-Chancellor, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, stated,
“Advances in genetic diagnostics and multidisciplinary clinical care are enabling earlier identification and more effective management of rare and complex conditions. Such integrated approaches are essential to improving patient outcomes and ensuring continuity of care, while compassionate, patient-centric care remains central to our approach to healing.”
Dr. Yashraj P. Patil, Trustee and Treasurer, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, said,
“The successful management of complex cases such as bilateral pheochromocytoma reflects the strength of collaborative clinical expertise and advanced surgical capabilities. Strengthening such integrated care systems is key to addressing evolving healthcare challenges.”
