April - June 2009, Volume 5, Issue 2

Datcu MD, Datcu G, Fermesanu I, Aursulesei V

Pheochromocytoma – late diagnosis after subarachnoid haemorrhage

Acta Endo (Buc) 2009, 5 (2): 265-274
doi: 10.4183/aeb.2009.265

Background: Despite a low incidence and prevalence, pheochromocytoma requires a\r\nparticular attention when evaluating hypertensive patients. If undiagnosed, the excessive\r\nand prolonged secretion of catecholamines may cause considerable cardiovascular\r\nmorbidity and mortality. The wide variability of clinical manifestations makes the diagnosis\r\ndifficult, and biochemical confirmation of the disease is mandatory.\r\nCase report: a 32-year-old patient, admitted to hospital with acute left ventricular\r\nfailure caused by severe arterial hypertension associated with the clinical triad (headaches +\r\npalpitations + sweating). The debut of the disease was manifested with a subarachnoid\r\nhaemorrhage. The aetiology remains unclear in the absence of confirmed arterial\r\nhypertension antecedents. In subsequent months he had paroxysmal rhythm abnormalities\r\nassociated with ECG signs of left ventricular hypertrophy considered to be due to nonobstructive\r\nhypertrophic cardiomyopathy. For a period of further three years the patient was\r\nrepeatedly hospitalized for paroxystic elevations of blood pressure not responding to\r\nantihypertensive medication. He developed diabetes mellitus and was started on insulintherapy.\r\nDuring the recent hospitalization, the diagnosis of pheochromocytoma was\r\nconsidered in view of clinical history and the severe hypertension-induced organ damage.\r\nThe diagnosis was confirmed biochemically and a right adrenal tumour was demonstrated\r\non CT. After a successful open adrenalectomy his hypertension was cured.\r\nIn conclusion, the case presented highlights the importance of recognising the symptoms\r\nand clinical signs suggestive of PHEO in order to reach a correct and timely diagnosis.

Keywords: Pheochromocytoma, Thomas-Roth-Kvale triad, paroxystic arterial\r\nhypertension, urinary metanephrines

Correspondence: Viviana Aursulesei, MD, PhD, 1st Department of Medical Cardiology, “St.\r\nSpiridon” University Hospital, Independentei Str. 1, Iasi, Romania, Tel: +40232219466,\r\nE-mail: aursuleseiv@yahoo.com