HEMORRHAGIC PHEOCHROMOCYTOMA AND SEVERE CAROTID STENOSIS: A MULTIDISCIPLINARY APPROACH TO SURGICAL PRIORITIZATION.

Introduction: Pheochromocytomas are rare catecholamine-secreting tumors that may present with nonspecific symptoms or life-threatening crises. Spontaneous adrenal hemorrhage is a rare complication that complicates diagnosis, especially in patients with comorbidities. Case Report: A 68-year-old male presented with severe abdominal pain, a history of hypertensive crises, and episodes of syncope. Imaging revealed a retroperitoneal hematoma originating from the right adrenal gland. Biochemical evaluation confirmed pheochromocytoma, and further imaging showed 75% stenosis of the right internal carotid artery. A multidisciplinary team recommended right adrenalectomy prior to carotid intervention. After alpha-blockade with phenoxybenzamine, the patient underwent successful adrenalectomy and hematoma evacuation. Histopathology confirmed pheochromocytoma with hemorrhagic and degenerative features. Carotid artery stenting was performed postoperatively. Discussion: Hemorrhagic pheochromocytoma may mimic other acute abdominal or vascular conditions, especially in patients on anticoagulation. Noradrenergic pheochromocytomas are linked to a higher risk of atherosclerosis. In such complex scenarios, surgical sequencing must be individualized. Conclusion: In patients with hemorrhagic pheochromocytoma and significant vascular disease, early tumor resection followed by vascular intervention can reduce perioperative risks. A multidisciplinary approach is essential for optimal outcomes.