Atypical presentations of Phaeochromocytoma – a clinical case report

Abstract

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.