Endocrine Abstracts

Background: Phaeochromocytoma is a rare neuroendocrine tumour of the adrenal medulla, accounting for less than 0.2% of hypertension cases. Classic symptoms include episodic headache, sweating, and tachycardia.

Aims: 1. To raise awareness of the symptoms and early diagnosis of pheochromocytoma. 2. To discuss management of phaeochromocytoma-related hypertension.

Case Presentation: A 75-year-old woman presented with intermittent dizziness, headaches, and elevated blood pressure (185/82 mmHg) four years ago. She was started on Amlodipine. One year later, her symptoms worsened, with erratic BP (170/105 mmHg), dizziness, diaphoresis, weight loss, and falls. Ramipril was added. After presenting with decompensated heart failure, she had multiple hospital admissions for chest pain, initially treated as acute coronary syndrome. However, coronary angiography showed normal arteries, and she was diagnosed with Takotsubo cardiomyopathy. A CT scan incidentally found a 4 cm adrenal nodule, which had grown since a previous scan. MRI confirmed a 4.2 cm adrenal mass suspected to be phaeochromocytoma. Urine metanephrines were elevated at 12.94 and 10.38 µmol/24h (normal <2 µmol/24h). She was started on phenoxybenzamine and is awaiting adrenalectomy.

Discussion: 1. Phaeochromocytoma should be suspected in patients with hypertension, headaches, and sympathetic hyperactivity. 2. Diagnosis is confirmed by measuring urine or plasma metanephrines. 3. Incidental adrenal tumours require endocrine evaluation. 4. Delayed diagnosis can lead to complications like hypertensive crises and Takotsubo cardiomyopathy. 5. Treatment involves alpha-adrenergic blockers and adrenalectomy where indicated.