Introduction: Phaeochromocytoma is a rare neuroendocrine tumour, with serious and potentially lethal cardiovascular complications. Cerebral haemorrhage is an unusual complication of phaeochromocytoma with <40 cases reported worldwide.
Case: We report the case of a 29-year-old woman who presented with sudden onset of headache and collapse. CT Brain showed right sided frontal haemorrhage, her BP > 200/100, LVH on ECG and Echocardiography suggesting long standing hypertension. Her cerebral angiography showed no sign of an AVM or other vascular abnormality.
Phaeochromocytoma was clinically suspected and appropriate antihypertensive drugs commenced. Further investigations for possible related endocrinopathies revealed very high urine normetadrenaline 44 umol/24 h (<4.3), high urine metadrenaline 0.7 umol/24 h (<2.0), and raised plasma normetadrenaline 9.56 (<1.09). CT abdomen confirmed a large left adrenal mass (4.6×2.7×5 cm) consistent with a phaeochromocytoma.
She has improved neurologically and transferred to neurorehabilitation centre. She would be candidate for the surgery in the next few months.
This lady phaeochromocytoma may be sporadic or part of MEN2 or Von hipple landau syndrome or familial paraganglioma syndrome (SDH deficiency), MEN2 genetic screen requested.
Conclusion: Hypertensive crises in phaeochromocytoma can become manifest in many different ways, including cerebrovascular accident. Early recognition of the symptoms of phaeocromocytoma and prompt appropriate intervention can prevent a potentially fatal outcome.