Endocrine Abstracts

Introduction: Pheochromocytoma is one of the major secondary causes of hypertension. The classic triad of pheochromocytoma symptoms of headache, sweating and tachycardia is not present in a high percentage of patients and is sometimes diagnosed as incidentaloma or atypical presentations.

Case report: The authors present a 56-year-old man, with no known diseases, referred to Endocrinology evaluation by incidentaloma of the right adrenal gland, from the Pneumology appoitment, where he was followed by persistent cough, after an episode of bronchospasm. From the complementary study, a 32 mm nodule in the right adrenal gland was observed on thoracic computed tomography and confirmed by MRI. Bronchofibroscopy with bronchoalveolar lavage and functional respiratory tests were also performed, which were normal. Patient didn’t refer any symtoms, however, he maintained a sustained hypertension in the ambulatory monitorization. Analytically, there was a significant increase in the urinary normetanephrines (2585 ug/24 h for a reference value <390) and urinary metanephrines (1551 ug/24 h, for a reference value <320), as well as plasma noradrenaline (1107 pg/ml for a reference value <750) and plasma adrenaline (137 pg/ml, for a reference value <110). Remaining study was without alterations, namely renin-angiotensin-aldosterone axis, thyroid function and urinary free cortisol. Patient started alpha-adrenergic blockade with phenoxybenzamine and laparoscopic adrenalectomy was performed 3 weeks later. Pathological anatomy confirmed diagnosis of pheochromocytoma.

Conclusion: Authors present a case of atypical presentation of pheochromocytoma. The respiratory airways are sensitive to the effects of catecholamines. Although they have mainly beta-adrenergic receptors, there are also alpha receptors that may explain the patient’s clinical condition (bronchospasm).

Given the existence of multiple presentations, detection of a pheochromocytoma might be difficult but is mandatory, not only for the potential cure of the hypertension but also to avoid the potentially lethal effects of the unrecognized tumor.