Endocrine Abstracts

JOINT243

Pheochromocytomas are rare tumors located in the adrenal medulla, that derives from the chromaffin cells and produce catecholamines. It has an annual incidence of approximately 0.8 per 100,000 person-years. Sustained or paroxysmal hypertension (HT) is the most frequent sign of pheochromocytoma. Classically, pheochromocytoma manifests as spells with the following 4 characteristics: headaches, palpitations, diaphoresis and severe hypertension. Here we describe the case with classical presentations of pheochromocytoma.

Case presentation: A 41-year-old female, without known co-morbidities, presented with episodes of high blood pressure (BP) of 220/110mmHg, headache, palpitation, tremor and sweating during last 20 days. On physical examination, she had pale skin and no other change. Electrocardiogram showed sinus tachycardia, 140bpm, incomplete RBBB, (-T1) V1-V6. The troponin I level was 5.78pg/mL (N 0-20). Echocardiography was not significantly abnormal. Laboratory studies revealed an elevated urinary metanephrines secretion of 493 mg/24h (normal value under 312 mg/24h) and also an elevated urinary normetanephrine of 515 mg/24h (normal value under 445 mg/24h). An abdominal computed tomography (CT) scan was performed, and a 6 cm large tumor in the left adrenal gland was found in. There were no other significant changes. A diagnosis of pheochromocytoma was made. Treatment with alpha- and beta-adrenergic blockers were initiated to adequately normalize BP prior to surgery. After 10 days, the patient successfully underwent laparoscopic left adrenalectomy. Histopathological evaluations confirmed the diagnosis of pheochromocytoma. After surgery, the patient’s medications were discontinued and BP and blood sugar were in a normal range. The patient was advised to do genetic testing and to return regularly for outpatient visits.

Conclusion: Pheochromocytoma responsible for less than 1% of patients presenting with hypertension. Although a rare condition, pheochromocytoma can be life-threatening, due to hypovolemia, catecholamine cardiomyopathy or respiratory disorder and should be considered as a differential diagnosis, especially in young patients presenting with unexplained hypertension, chest pain and cardiac dysfunction.