Endocrine Abstracts

A 57 year old lady was admitted to hospital with right flank pain radiating to the right shoulder. Subsequent work-up revealed an acute right adrenal haemorrhage of size 82 x 53 x 56 mm on CT abdomen and pelvis, with CT angiogram confirming no ongoing haemorrhage. Biochemistry showed significantly elevated plasma metanephrines and normetanephrines, with unremarkable adrenal profile otherwise. She had been experiencing palpitations, excessive diaphoresis and headaches on a background of hypertension, for which she was on lercanidipine. Some of the symptoms were attributed to the menopause, for which she was taking HRT prior to hospital admission, albeit without complete symptom relief. At 6 weeks follow-up following discharge, plasma metanephrines had normalised but normetanephrines remained elevated, albeit significantly improved, as shown in the table below. Due to ongoing palpitations and hot flushes, Lercanidipine was switched to Doxazosin, which provided symptom relief and improved blood pressure. A repeat CT adrenal at 2 months follow-up, showed significant size reduction in the haematoma to 47 x 29 mm. However, plasma normetanephrine remained elevated at 4 months post admission. A subsequent MIBG scan revealed increased uptake within the right adrenal nodule suggestive of phaeochromocytoma. The case highlights the difficulty in distinguishing between elevated plasma metadrenalines secondary to haemorrhage in a normal adrenal gland or a nonfunctional adrenal tumour and haemorrhage associated with an underlying pheochromocytoma. The presence of pre-existing adrenergic symptoms and a positive functional scan helped distinguish between the 2 scenarios in our case.