A previously hypertensive pregnant woman exhibited severe and prolonged hypotension following resection of a functioning paraganglioma lying at the brim of the pelvis. It was necessary to support the blood pressure with a norepinephrine drip for 48 hours following operation. Serial measurements of norepinephrine concentration in blood and urine supported the hypothesis that, following tumor resection, the normal and usually adequate levels of norepinephrine may not be sufficient to maintain effective peripherovascular tone. It is concluded that the neuroreceptors may thus be relatively insensitive, temporarily, to norepinephrine, the hormonal mediator of neurovascular tone. Thus, if adequate blood volume replacement has been achieved, postresectional hypotension is logically managed with norepinephrine therapy.
Hardy JD, McPhail JL, Gallagher WB. Pheochromocytoma: Shock Following Resection: Notes on Mechanism with Catechol Amine Measurements in Case During Pregnancy. JAMA. 1962;179(2):107–111. doi:10.1001/jama.1962.03050020001001
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