Managing Headache and Palpitations: Pheochromocytoma Diagnosis and Treatment
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A 55-year-old woman presented with a 1-year history of headaches and 6-month history of palpitations. Laboratory and imaging tests found elevated urine and plasma metanephrine levels and a 3.5x2.7 cm left adrenal lesion, suggestive of a pheochromocytoma. She underwent a laparoscopic left adrenalectomy, and pathology confirmed pheochromocytoma. Her hypertension improved post-operatively.
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Managing Headache and Palpitations: Pheochromocytoma Diagnosis and Treatment
- 1. Rani 55F
- 2. Chief complaints • 55 year old housewife presented with • Headache for 1 year • Palpitations for 6 months
- 3. HOPI • H/o headache for 1 year • Dull aching type • Paroxysmal in nature • No aggravating and relieving factors • Associated with profuse sweating. • H/o palpitation for 6 months • Spontaneous in onset • Associated with shortness of breath • No aggravating and relieving factors
- 4. • No H/o urge incontinence • No h/o hematuria/ pyuria/calcaluria/ abdominal pain/ fever/ vomiting/ oliguria • Patient was referred from General medicine dept
- 5. Past History • Patient treated for PTB 9 years ago and completed 6 months of ATT • K/C/O HTN x 5 years on T. Losartan 50 BD, T. Atenolol 50mg BD, T. Hydrochlorthiazide 12.5 BD. • No other comorbidities • No past surgical history Personal History • Not a smoker or alcoholic • Takes a mixed diet • Normal bowel and bladder habits Family History – No H/o similar complaints in the family
- 6. General Examination • Patient is moderately built and well nourished • Afebrile • No pallor • No icterus • No pedal edema • No generalized lymphadenopathy • Vitals: • BP 140/90 mm hg • PR 74/ min
- 7. Per abdominal examination • On inspection- All quadrants move equally with respiration Umblicus is in midline Hernial orifices free. • On palpation – No warmth No tenderness No guarding , no rigidity Bladder not palpable • On percussion – No e/o free fluid • On auscultation –Bowel sounds present.
- 8. Systemic Examination • CVS-S1S2+ • RS-BAE+ • CNS-NAD
- 9. Investigations • Urine R/E • Albumin- nil, • Sugar- nil, • Deposits - 0-2 pus cells /HPF • Urine c/s –no growth
- 10. INVESTIGATIONS • Hb- 11.4g/dl, • TC- 9400 • DC- 70/15/12 • PLT- 2.4 L • Urea – 34 mg/dl • Creatinine – 1.1mg/dl • Na+ - 138meq/l • K+ - 4.1meq/l • PT- 12.9 • INR- 1.00
- 11. Investigations • Blood cortisol- 20.51 mcg/dl (10-20mcg/dl) • Urine metanephrines- 395.99mcg/24 hours (24 - 96mcg/24 hours) • Urine normetanephrines- 1365.94mcg/24 hours (75 – 375mcg/24 hours) • Plasma free metanephrines • Normetanephrine – 289pg/ml (18-111pg/ml) • Metanephrine – 114pg/ml (12-60pg/ml)
- 12. MRI ABDOMEN
- 16. MRI Abdomen • Well defined T2 hyperintense lesion measuring 3.5x 2.7 cm noted in left adrenal .There is no signal loss in the out of phase imaging, possibly- malignancy/lipid poor adenoma.
- 17. • Patient underwent Laparoscopy assisted Left adrenalectomy on 4/10/19
- 18. • HPE - Consistent with Pheochromocytoma
- 19. • Post op uneventful • Hypertension was well controlled in the post operative period and requirement of antihypertensives was reduced
- 20. CT chest
- 21. CT THORAX • Post TB sequele with reactivation, lipid poor adenoma left adrenal gland 3x3 cm with CT attenuation +40HU with cholelithiasis.