Nonclassic presentation of pheochromocytoma: difficulties in diagnosis and management of the normotensive patient.
Publication/Presentation Date
1-1-2008
Abstract
OBJECTIVE: To report an unusual presentation of pheochromocytoma along with challenges in diagnosis and management.
METHODS: We report a clinical case history and describe diagnostic methods and pitfalls. The preoperative medical preparation in a normotensive patient is described.
RESULTS: A 33-year-old man fell off a ladder, resulting in C6 paraplegia. After C7-T1 laminectomy, he was transferred to a rehabilitation center where he reported lightheadedness, shortness of breath, and chest pain during therapy sessions. A left adrenal mass was incidentally discovered during the workup to rule out a pulmonary embolism. He reported no history of hypertension, and no elevated blood pressure readings had been documented. Magnetic resonance imaging of the adrenal glands showed a well-defined left adrenal mass measuring 3.9 x 3.2 x 3.3 cm, which was hyperintense on T2-weighted images. Twenty-four hour urinary catecholamine concentrations were unremarkable; urinary metanephrines were markedly elevated. During hospital admission, blood pressure was in the low to normotensive range, requiring a cautious approach to alpha-adrenergic blockade and surgical preparation. He under-went uneventful laparoscopic left adrenalectomy; surgical pathology was consistent with pheochromocytoma.
CONCLUSIONS: This case illustrates a nonclassic presentation of pheochromocytoma and demonstrates that urinary catecholamines alone are not sufficient for a biochemical diagnosis of large pheochromocytomas. Preoperative preparation in normotensive patients can be achieved with alpha-adrenergic blockade, hydration, and liberal salt intake.
Volume
14
Issue
4
First Page
470
Last Page
473
ISSN
1934-2403
Published In/Presented At
Gonzalez-Pantaleon, A. D., & Simon, B. (2008). Nonclassic presentation of pheochromocytoma: difficulties in diagnosis and management of the normotensive patient. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 14(4), 470–473. https://doi.org/10.4158/EP.14.4.470
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
18558602
Department(s)
Administration and Leadership
Document Type
Article