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Case Reports: Unusual presentation of more common disease/injury
Benign phaeochromocytoma presenting with recurrent spells and negative biochemical screening
  1. Jamal Abukhaled1 and
  2. Alexander Michael Balinski2
  1. 1Department of Nephrology, Beaumont Health, Royal Oak, Michigan, USA
  2. 2Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
  1. Correspondence to Alexander Michael Balinski; balinski{at}oakland.edu

Abstract

A woman in her 40s presented with spells of hypertension, warmth, flushing and bradycardia for more than 1 year. Despite normal plasma metanephrines of 0.48 nmol/L (reference range: <0.50 nmol/L) and normal 24-hour urine metanephrines of 199 µg/day (reference range: 52–341 µg/day), an abdominal CT scan was obtained which revealed a 1.7 × 1.4 cm right adrenal gland nodule. During her next spell, 24-hour urine metanephrines were elevated at 585 µg/day with total metanephrines of 1026 µg/day (reference range: 140–785 µg/day). Subsequent MRI demonstrated a 1.5 × 1.5 cm right adrenal gland lesion concerning for phaeochromocytoma. Right adrenal gland excision was performed and pathology confirmed a benign phaeochromocytoma. Follow-up genetic testing was negative. This case highlights the challenges of identifying phaeochromocytomas in the clinical setting. Early imaging may assist in the timely diagnosis and treatment of these tumours in patients presenting with recurrent spells and negative biochemical screening.

  • adrenal disorders
  • hypertension
  • pathology
  • arrhythmias

https://doi.org/10.1136/bcr-2022-251113

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    Footnotes

    • Contributors JA: conceptualisation, interpretation, investigation, supervision, writing—original draft and writing—review and editing. JA is the guarantor. AMB: literature review, writing—original draft and writing—review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.