Atypical presentations of Phaeochromocytoma – a clinical case report

• Autor(a) principal: Ruivo, Jorge
• Data de Publicação: 2008
• Outros Autores: Tomada, Ana, Alcântara, Paula
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1494
• topic: feocromocitoma; atípico; não secretor; necrose; maligno; phaeochromocytoma; atypical; necrosis; malignancy; non-secreting

Introduction: Phaeochromocytoma is a rare neuroendocrine tumour. The biochemical and clinical features derive mainly from excessive catecholamine production. When there is mass necrosis, these tumours may reveal themselves through a huge release of hormones. We present the case of a 42 year old female attending a Hypertension outpatient clinic because of fainting episodes and high blood pressure. She was diagnosed with hypertension at the age of 18 years and was being treated for severe depression.She had no complaints until 3 months earlier when she started suffering from “hard-to-assess” episodes of fatigue, trembling, headache, blurred vision and faintness. SBP was 160-200 mmHg. She had a slow psychomotor response and reduced facial expression. She presented with inconsistently elevated urinary metanephrines and CT scan showed a 3.4 cm mass, with a necrotic center, in her left adrenal gland. Phaeochromocytoma was confirmed with an IMBG scintigraphy. She underwent laparoscopic removal of the mass and histology revealed phaeochromocytoma.Discussion: A diagnosis of Phaeochromocytoma is hard to make because of a number of factors: the rising number of incidentalomas; the technical difficulty in combining biochemical and imaging exams; numerous drug interactions with biochemical results as well as a lack of clinical suspicion when facing unusual presenting features, such as hypotension. Tumour necrosis is usually associated with devastating clinical presentations, which were not present in this patient.