CHENNAI: When 48-year-old flower seller Kanthammal walked into the general clinic at the Government Kilpauk Medical College and Hospital, complaining of severe back pain and head ache, she had no idea how close to a cardiac arrhythmia she was. The ultrasound exam revealed a massive cyst-like presence in her left adrenal gland. “Though the incidence is extremely rare, we suspected that she might have a tumour in the adrenal gland,” says medical superintendent Dr R Sukumar.Though curable if detected, finding an adrenal tumour is a difficult procedure, because there are very few external symptoms that indicate a serious problem, explains Dean Dr S Geethalakshmi. If unattended, it can cause fatality through rapid hypertension, cardiac arryhthmias and other complications.A CT scan confirmed the presence of pheochromocytoma or adrenal tumour. “A continous urinary test confirmed our fears that it was a functioning tumour,” adds Santhaseelan, for if it had been non-malignant, the risk factor was low. After a consultative meet, the six-member team of surgeons steeled themselves for the complex surgery, the likes of which had never been attempted at KMC. “It was an anaesthetic challenge like no other,” says Dr S Gunasekaran, chief anaesthesiologist. “We used three times the amount of drugs used on a normal patient to keep her stable,” he adds.When the surgery began at 10am on July 27, Kanthammal’s daughter Revathi had very little hope that her mother would survive the pain. The doctors were riddled with complications, foremost of them being the fluctuating blood pressure of the patient. “When we began, her BP was around 275/145 and we had to stabilise it by giving her suitable anaesthetic drugs,” explains Gunasekaran. However, when the tumour was being severed, the loss of adrenal hormones that it had been secreting, resulted in a rapid plunge in her BP. “It plummetted to 20/50 and stayed there for a while,” he adds. Once the tumour was removed, the BP spiked again, necessitating more drugs that made her system unstable, “We lost hope and thought that she would go into (cardiac) arrest soon,” recounts Sukumar. Miraculously, the woman’s condition stabilised around 4 pm.“They replenished her body with 10 units of blood and equal quantities of plasma and platelets. Besides this we used an intra-arterial pressure monitor for the first time,” says Geethalakshmi. Other than some internal bleeding, the flower vendor was fine when the doctors put her on ventilator for the next 48 hours. Dr V Selvaraj, Professor of Urology says that he was surprised at the size of the removed tumour. “Normally tumours can range from 2x2cm but this one was 12x12cm; roughly the size of a small ball,” he says. Though feeble, the patient is recovering well and will be discharged in a few days, says Sukumar.
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