Endocrine Abstracts

Introduction: Pheochromocytoma (PHEO) is a rare neuroendocrine tumor, which presents with various clinical phenotypes, depending on the size of the tumor, the secreting activity, and the secreting product. Large PHEOS exhibit symptoms related to mass effects and malignant PHEOS symptoms related to metastases. Some PHEOS present as adrenal incidentalomas (AI) or with an unusual clinical phenotype.

Case report: A 54-year-old Russian female presented with severe anemia and thrombocytosis in addition to nonspecific symptoms, for 6 months (weakness, fatigue, anorexia, weight loss). Clinical examination revealed skin and conjunctival paleness, sinus tachycardia and mild edema of the lower extremities. Laboratory testing revealed anemia, thrombocytosis, increased inflammation markers, severe hypoalbuminemia, and albuminuria. The abdominal CT scan revealed a right AI, sized 9×7×8 cm, with heterogeneous uptake, possible liver infiltration and thrombosis of the inferior vena cava. The hormonal evaluation showed increased levels of 24 h-urine metanephrines. She underwent right adrenalectomy, nephrectomy, and splenectomy. Histopathology confirmed the diagnosis of a pheochromocytoma. The patient showed full recovery at the 3-month follow-up.

Conclusion: This case concerns a PHEO presented as AI with anemia, thrombocytosis, and proteinuria, namely an atypical clinical phenotype. The early recognition and diagnosis contribute to the safe treatment and better course of the disease and its comorbidities.