Endocrine Abstracts

Pheochromocytoma is a rare catecholamine-secreting tumor. It is potentially curable but can cause life-threatening hypertension or cardiac arrhythmias. We report a 58- years- old woman with no significant past medical history who was admitted through the emergency department with complaints of chest pain, palpitation, and nausea. She reported six months history of episodic palpitation and throbbing headaches, sometimes associated with light-headedness and dizziness. Hence, she kept a meticulous diary of her blood pressure and heart rate, and indeed she had erratic blood pressure and heart rate during these episodes. She was anxious, tachycardic, had a systolic cardiac murmur and had no signs of decompensated heart failure on examination. Investigations revealed; Normal ECG with incrementally rising troponins at levels of 1577 Ng/l and 2577 Ng/l. She was initially managed for acute coronary syndrome (ACS); however, her presentation was atypical; hence she subsequently underwent a CT pulmonary angiography which ruled out pulmonary embolism but picked up an incidental 45 mm left adrenal mass. Later, an MRI adrenal was performed and confirmed the CTPA findings. Moreover, it showed a fluid level suggestive of possible recent intra-adrenal haemorrhage. Her Plasma metanephrines and normetanehrines were approximately 4 and 6 times the upper limit of the reference range, respectively, cortisol level and thyroid enzymes were within normal limits, Echocardiogram was normal. She was commenced on alpha-blockade followed by beta-blockade with good effect in controlling blood pressure and heart rate before she had left adrenalectomy.

Learning points: 1. Pheochromocytoma diagnosis needs a high index of suspicion as variable presentation 2. Pheochromocytoma, if not treated promptly, may lead to fatal cardiac complications.