VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

33 Bilateral Pheochromocytoma in a 28 Year Old Female

Christopher Sue-Wah-Sing, DO; David Mahoney, M.D Corresponding author: Christopher.suewahsing@hcahealthcare.com

LewisGale Hospital Montgomery

Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia are referred to as "pheochromocytomas" and "catecholamine secreting paragangliomas" ("extra-adrenal pheochromocytomas"), respectively. Catecholamine secreting tumors (such as Pheochromocytomas) are rare neoplasms, in less than 0.2 percent of patients with hypertension[citation]. Estimations of the annual incidence of pheochromocytoma is approximately 0.8 per 100,000 person-years[citation]. Most catecholamine-secreting tumors are sporadic. However, approximately 40 percent of patients have the disease as part of a familial disorder[citation]; in these patients, the catecholamine-secreting tumors are more likely to be bilateral adrenal pheochromocytomas or paragangliomas.

There are several familial genetic disorders associated with pheochromocytomas, which include von Hippel-Lindau (VHL) syndrome, multiple endocrine neoplasia type 2 (MEN2), and less commonly, neurofibromatosis type 1 (NF1) [citation]. The classic triad of symptoms in patients with a pheochromocytoma consists of episodic headache, sweating, and tachycardia. The diagnosis of pheochromocytoma is typically made by measurements of urinary and plasma fractionated metanephrines and catecholamines. If lab results are appropriately elevated, Computerized tomography or Magnetic resonance imaging of the abdomen and pelvis is usually performed, however, many times pheochromocytomas are found incidentally on imaging prior to any lab work. Treatment is surgical removal of the pheochromocytoma while keeping in mind blood pressure control prior to surgery, such

as Combined alpha and beta-adrenergic blockade, in order to prevent intraoperative hypertensive crises. This will be a clinical review of a rare case of bilateral pheochromocytoma in a young female, where the patient did not present with the classic triad of symptoms (episodic headache, sweating, and tachycardia), but rather transiently elevated readings of blood pressure, with systolic blood pressure readings above 200mmHg.

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