We report a case of a male patient aged 45 years who presented with a history of intermittent back discomfort over a year, but more persistent over the previous 23 months. His general practitioner (GP) referred him for an ultrasound of the spine for a possible encapsulated lipoma but the findings were unremarkable. He was then referred to a consultant gastroenterologist for further assessment. He had normal endoscopic examinations, however the MRI had shown a right adrenal lesion which led to a referral to the endocrine team.
On further history he reported episodes of perspiration and bursts of aggression, for the past few years. Investigations revealed a normal cortisol response following overnight dexamethasone suppression and a normal renin aldosterone ratio.
He had elevated 24-h urinary normetanephrines 6360 nmol/24 h and metanephrines 2530 nmol/24 h (normal <2129 and <1622 respectively), in keeping with phaeochromocytoma. Subsequent meta-iodobenzylguanidine (MIBG) scan showed prominent activity in the region of the right adrenal gland. The patient was initially commenced on an alpha blocker doxazosin, and the dose was incremented to the maximum of 16 mg BD. He was subsequently commenced on beta blocker bisoprolol, and his blood pressure dropped from average of 150/100 mmHg (no history of hypertension) to around 110/70 mmHg.
This patient had a right adrenalectomy, made an uneventful recovery and was discharged with no medication. His BP remained at around 130/85 mmHg at his post-operative consultations. Phaeochromocytoma presents with various forms of signs and symptoms. In our case, the history of episodes of intermittent perspiration, back pain and severe aggression were uncommon symptoms emphasising the importance of comprehensive history taking.
Since surgery the patient has no longer experienced any of the above, and he describes himself to be calmer than ever.
20 - 23 May 2017
European Society of Endocrinology