Pheochromocytoma releasing ACTH: two in one.
A. Adamska, J. Mysliwiec & M. Gorska
Introduction: Ectopic release of ACTH caused by pheochromocytoma is extremely rare. The clinical picture of hypercortisolism is overlapped by catecholamine excess that makes diagnosis more difficult.
Case report: A 74-year-old women was admitted to the hospital because of hypertension, recently diagnosed diabetes and weight loss (10 kg per six months). In physical examination: cachexia, dehydratation, pallor, hirsutism, proximal muscle weakness, elevated blood pressure, tachycardia and increased sweating. Laboratory studies revealed severe, resistant for treatment hypokalemia, elevated testosterone and 17-OH progesterone concentrations, severe hypercortisolism without circadian rhythm and not suppressed with 8 mg of dexamethasone; increased plasma ACTH concentration and elevated urinary cortisol and catecholamines levels. In CT tumoral mass in the right adrenal gland was found. The immunohistochemistry of the adrenal tumor confirmed diagnosis of both pheochromocytoma and ACTH.
Simultaneous secretion of catecholamines and ACTH by the same tumor is a very rare finding. Clinical implications of this co-secretion made diagnostics process more complicated and final diagnosis quite surprising.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.