Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2007) 13 P198

SFEBES2007 Poster Presentations Endocrine tumours and neoplasia (9 abstracts)

An unusual phaeochromocytoma crisis presenting with profound hypoglycaemia and subsequent hypertension

Katherine Davis 1 , Bernard Khoo 1 , William M Drake 1 , Ashley B Grossman 2 & Sarah Frankton 1

1Barts and the London NHS Trust, London, United Kingdom; 2Barts and the London School of Medicine, Queen Mary College, University of London, London, United Kingdom.

A 47 year old Macedonian Personal Trainer presented with 4 days of vomiting, abdominal pain and profuse sweating. He admitted abusing anabolic steroids 20 years previously but never insulin. The presenting capillary blood glucose (CBG) was 1.7 mmol/L, blood pressure (BP) 182/106 mmHg, pulse 62 bpm. On examination, he was sweaty, pale and cold. Blood was drawn for measurement of insulin, C-peptide, glucose, cortisol and thyroid function tests. He was treated with 50% dextrose and 100 mg i.m.hydrocortisone 6 hourly. The CBG rose to 7.1 mmol/L and BP dropped to 115/90 mmHg. The initial differential diagnosis was hypoglycaemia secondary to insulin abuse, hypoadrenalism or insulinoma, the transient hypertension being considered a consequence of sympathetic stimulation.

He remained symptomatically well overnight with a CBG of 10–14 mmol/L. Next morning he complained of nausea and abdominal pain. The BP had risen to 203/127, when he was reviewed and given 10 mg i.m. metoclopramide. Shortly afterwards, he developed acute pulmonary oedema and had become hypoglycaemic again. A phaeochromocytoma crisis was suspected and α-adrenoceptor blockade with i.v. phenoxybenzamine advised. However, the patient deteriorated and died on the ITU within 2 hours.

The following blood test results were received post-mortem: cortisol 1202 nmol/L, plasma glucose 1.8 mmol/L, insulin 25.2 mU/L, C-peptide 1174 pmol/L, indicating inappropriate endogenous insulin secretion; troponin T 3.4 μg/L and thyroid function was normal. Post mortem examination confirmed a phaeochromocytoma in the left adrenal, with haemorrhage within the head of pancreas, but no evidence of a pancreatic tumour nor of myocardial infarction.

This is an unusual case of a phaeochromocytoma crisis presenting with hypoglycaemia and only later with hypertension. The tumour did not stain for insulin and the mechanism of the hypoglycaemia remains unclear. Hypotheses include a β-adrenoceptor-mediated release of insulin from the pancreas, release of insulin from damaged pancreatic tissue, or co-secretion of incretins by the tumour.

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