Case history
Case history
A 33-year-old woman presents to her doctor complaining of a several-month history of episodic palpitations and diaphoresis. She states that her husband noticed that she becomes pale during these episodes. She has been experiencing progressive episodic headaches, which are not relieved by paracetamol. In the past, she has been told that she had a high calcium level. She has a history of clacium-based kidney stones. Her family history is unremarkable; specifically, there is no history for tumours, endocrinopathies, or hypertension. Physical examination reveals a BP of 220/120 mmHg and hypertensive retinal changes.
Other presentations
A phaeochromocytoma may present in a patient with classic symptoms associated with excessive catecholamine secretion (i.e., diaphoresis, headaches, palpitations, intractable or paroxysmal hypertension) or with a family history of phaeochromocytomas, or it may present as an incidental adrenal mass. However, the tumour can have an extremely variable presentation, making it a challenging diagnosis. Apart from the classic symptoms mentioned previously others include anxiety, epigastric pain, nausea, vomiting, and very rarely flushing.[3] Alternatively, the sole presenting complaint could be complications related to the intractable hypertension: for example, chest pain in a patient developing a myocardial infarction (MI). Due to the variety of hormones the tumour can produce, other unusual presentations may include Cushing syndrome from excess corticotrophin hormone or watery diarrhoea caused by excess vasoactive intestinal peptide (VIP) secretion.[6][7] Excessive catecholamine secretion may also lead to the development of new-onset diabetes and hyperglycaemia.[8][9] Increasingly, patients are asymptomatic, as these tumours are often diagnosed following work-up for an adrenal incidentaloma noted on imaging (CT scan, MRI).[10]
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