BES2002 Poster Presentations Clinical Case Reports (60 abstracts)
A near fatal case of haematuria
H Kumar 2 , L O'Shea 1 , M Joyce 2 , G Boran 3 , A Tanner 2 & J Barragry 1
1Department of Endocrinology, Adelaide and Meath Hospital incorporating The National Hospital for Sick Children, Tallaght, Dublin, Ireland; 2Department of Surgery, Adelaide and Meath Hospital incorporating The National Hospital for Sick Children, Tallaght, Dublin, Ireland; 3Consultant Chemical Pathologist, Adelaide and Meath Hospital incorporating The National Hospital for Sick Children, Tallaght, Dublin, Ireland
We present the case of a thirty five year old salesman in whom microscopic haematuria was detected during a routine employment medical. History and physical examination were unremarkable. A renal ultrasound initiated by the urology service revealed an upper abdominal mass. CT abdomen confirmed a 5x6cm lesion distinct from the right kidney and adrenal gland. A CT-guided biopsy precipitated a hypotensive crisis (90/60mmHg) and hypoglycaemia (blood glucose 2.3mmol/l). 24-hr urinary collections showed raised noradrenaline levels (579, 586, 573 nmols/24hrs) normal adrenaline levels. An I131MIBG scan confirmed the previously identified mid-abdominal area plus unsuspected high activity in the upper pharyngeal area with bony metastases in the anterior arch of C-2 vertebra on MRI. The primary lesion was excised with ongoing MIBG therapy to the metastatic deposit. Phaechromocytomas are uncommon catecholamine-secreting tumours. They may present atypically in diverse locations with 95% intra-abdominal. We believe a high index of suspicion combined with a and b -blockade is essential prior to invasive procedure of any intra-abdominal mass of unknown aetiology. Failure to suspect, especially nonendocrine services, may result in a fatality with medicolegal implications.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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