Endocrine Abstracts

Introduction: Pheochromocytoma is a rare neuroendocrine tumor that arises from chromaffin cells in the adrenal medulla or extra-adrenal paraganglioma. Typical triad of symptoms includes episodic headache, palpitations, and sweating occurring in 24% of patients [1].

Case presentation: A 48-year-old male with uncontrolled hypertension and intermittent palpitations for two years presented with moderate right abdominal pain and discomfort for a 2-month duration. Initial ultrasonography revealed right suprarenal mass, and further CT imaging suggested 17cm×13cm×15 cm-sized right adrenal mass encasing the aorta, with non-enhanced density of 22 HU, enhanced density of 140 HU, absolute washout of 43%, relative washout of 32% and two small nodules in the right lung compatible with pulmonary metastases. Metanephrines were grossly elevated. Clinically or biochemically there was no evidence of excess cortisol, aldosterone or sex-steroids. He was referred to oncology following resection of tumour. Histology revealed malignant pheochromocytoma with Pheochromocytoma of the Adrenal gland Scaled Score (PASS) score of 8/20.

Outcome: Compression on the liver, hemorrhagic necrosis, or rupture of the tumor may lead to abdominal pain in pheochromocytoma [2]. High catecholamine levels are responsible for constipation, paralytic ileus, and megacolon [3]. Understanding atypical presentations of pheochromocytoma is crucial for reducing morbidity and mortality in suspected cases.

References: 1. Gu YW, Poste J, Kunal M, Schwarcz M, Weiss I. Cardiovascular manifestations of pheochromocytoma. Cardiol Rev. (2017) 25:215–22. doi: 10.1097/CRD.0000000000000141. 2. Mhd Baraa Habib;Mohamed Abdelrazek;Sali Alatasi;Mouhand F. H. Mohamed;Hamda Ali;Mohamad Khair Hamad; (2021). Pheochromocytoma presenting with severe abdominal pain and abnormal liver enzymes . Clinical Case Reports, (), –. doi:10.1002/ccr3.4640. 3. Ann T. Sweeney, Alan O. Malabanan, Michael A. Blake, Antonio de las Morenas, Riad Cachecho, James C. Melby, Megacolon as the Presenting Feature in Pheochromocytoma, The Journal of Clinical Endocrinology & Metabolism, Volume 85, Issue 11, 1 November 2000, Pages 3968–3972, https://doi.org/10.1210/jcem.85.11.6947.