Sudden onset of a hypertensive crisis occurred shortly after induction of anesthesia in a patient with malignant pheochromocytoma, despite preoperative medical preparation with alpha-methyltyrosine (alpha-methyl-p-tyrosine) and propranolol hydrochloride. Other investigators have advocated alpha-methyltyrosine as the medical therapy of choice in the preoperative preparation of patients with pheochromocytoma. This case emphasizes the caution that should be exercised when using alpha-methyltyrosine preoperatively, without concurrent alpha-adrenergic blocking agents, to prevent intraoperative hypertensive crisis.
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