Perioperative hypertensive crises during adrenalectomy: a challenge for anesthetists

Severe hemodynamic instability may develop during adrenalectomy for hormonally active adrenal masses. In two patients diagnosed with pheochromocytoma and Conn syndrome, recurrent refractory hypertensive crises were observed during surgical manipulation despite adequate preoperative preparation and sufficient anesthesia. These cases demonstrate the importance of close hemodynamic monitoring and a multimodal pharmacological approach to hypertension during adrenalectomy.