Introduction: Phaeochromocytoma of the urinary bladder is a rare neoplasm and accounts for <1% of all phaeochromocytomas. It is more common in females and the majority of patients present in second and fourth decade. Its common presentation is painless haematuria, headache, palpitation, hypertension and syncope during or immediately after urination.
Case history: We present a case of 48-year-old man who presented to Endocrinology with a few months history of having increased bouts of headaches associated with palpitations and feeling generally unwell during micturition. He had a background history of type 2 diabetes and hypertension for which he was on Metformin and Candesartan. During these episodes his systolic blood pressure rose to 250 mmHg (asked to self monitor) with reduction of his symptoms spontaneously within minutes.
Twenty-four hour urine catecholamine collection was requested to exclude phaeochromocytoma. This showed highly elevated noradrenaline levels 16.9μmol/24 h specimen (0.070.48) and normetadrenaline levels 45.6 μmol/24 h specimen (00.3). Urinary dopamine was also elevated at 4.21 μmol/24 h specimen (0.492.85).
CT scan showed a bladder mass with subsequent staging CT confirming a 5.4 cm vascular mass relating to the bladder wall. No other masses were demonstrated and his adrenal glands were normal. The clinical diagnosis of solitary phaeochromocytoma of the urinary bladder was made. He was started on Phenoxybenzamine and referred to surgeons and is currently awaiting partial cystectomy.
Discussion: Though this condition is rare, the history was key in raising the index of suspicion, thereby helping early diagnosis and treatment of the tumour.
Because of its rarity, diagnosis may however be difficult and delayed despite the characteristic diagnostic clues associated with micturition.