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Pheochromocytoma: Shock Following Resection-Reply

James D. Hardy, M.D.
JAMA. 1962;180(9):793. doi:10.1001/jama.1962.03050220085019.
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To the Editor:—  While Dr. Robbins believes that the hypotension which follows resection of a pheochromocytoma may well be due to adrenocortical insufficiency, other correspondents have stressed with equal vigor the possibility of hypovolemia. Of course, upon occasion either of these conditions might exist.Nevertheless, one feels that certain evidence should be cited to support our original hypothesis, namely, that a relative but temporary catechol amine insufficiency is a major factor in permitting the postresectional hypotension observed in many cases. First, we (Ann Surg150:679, 1959) and others (Hume, Amer J Surg99:458, 1960) have published urinary corticoid values in patients before and following resection of pheochromocytomas. In most instances the values have been within normal limits. Second, the hypotension in the case reported occurred immediately after the venous drainage from the paraganglioma had been clamped, too soon to represent development of the metabolic state of adrenocortical insufficiency;


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