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 acetaminophen. In the past, she has been told that she had a high calcium level. She has a history of calcium-based kidney stones. Her family history is unremarkable; specifically, there is no history for tumors, endocrinopathies, or hypertension. Physical exam reveals a BP of 220/120 mmHg and hypertensive retinal changes.
Other presentations
A pheochromocytoma 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 pheochromocytomas, or it may present as an incidental adrenal mass. The tumor 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 tumor can produce, other unusual presentations may include Cushing syndrome from excess corticotropin hormone or watery diarrhea caused by excess vasoactive intestinal peptide (VIP) secretion.[6][7] Excessive catecholamine secretion may also lead to the development of new-onset diabetes and hyperglycemia.[8][9] Increasingly, patients are asymptomatic, as these tumors are often diagnosed following workup for an adrenal incidentaloma noted on imaging (CT scan, MRI).[10]
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