63-year-old lady for Elective Ventriculo-Peritoneal shunt 

Background

• Hydrocephalus – obstructive symptoms with increasing cognitive decline and decreasing mobility over recent weeks 
• Phaeochromocytoma – Retroperitoneal Left adrenalectomy performed June 2021.
• Hypertensive eye disease
• Neurofibromatosis Type 1 – associated with Phaeochromocytoma

Issues:

• Attended on DOS – Concern that hadn’t had endocrinologist follow up post-adrenalectomy
• Original imaging had suggested possibility of other sites of phaeochromocytoma
• BP range acceptable since surgery but still taking alpha and beta blockers
• No repeat plasma catecholamine levels since discharge.

Discussion

• Normotensive and asymptomatic –on metoprolol and Prazosin. Phenoxybenzamine ceased post-operatively and prazosin dose reduced from 12mg daily to 2mg daily
• Concern regarding increased risk of haemodynamic lability intraoperatively
• Endocrinologist consulted – advised to recheck plasma catecholamines, which were raised and repeat Dotatate scan.
• What is a Dotatate scan? – Somatostatin receptor-based imaging. From up to date “Several new positron emission tomography (PET) tracers for imaging have emerged (such as 68-Ga DOTATATE and 68-Ga DOTATOC), which in combination with CT, improve the detection and staging of neuroendocrine tumours. These novel PET modalities offer higher spatial resolution than conventional scanning and are associated with improved sensitivity for detection of small lesions…” 

Plan:

• Postpone for 1 month
• Await repeat Dotatate scan and endocrinologist review