Case Study of Pheochromocytoma in a 24-year-old Woman

Abstract

Pheochromocytoma is a type of neoplasm that grows out of cells called chromaffin cells, found
in the adrenal glands (Neumann et al., 2019). Chromaffin cells are the cells that produce
hormones. The symptoms of the rare tumour experienced are due to the production of excess
catecholamine from the tumour. In the case in the study, the patient has shown sudden recurrence
of hypertension. These frequent attacks have recurred over the last six months and have caused
headaches, blurred vision, sweating, and heart palpitations. Confirmation by 24-hour urinary
catecholamine and norepinephrine levels, is conducted. There is an increase in the levels. CT
(Computed Tomography) scan of the abdomen and transabdominal USG. Surgery was done on
the patient, but she had gotten prior preparation for theatre by using phenoxybenzamine (alpha-
blocker) and propanol. Blood pressure fluctuation was managed well by intravenous fluid
overload. Important to note is that pheochromocytoma is a rare cause of hypertension. When
identified early, it is treatable through surgical removal. If neglected, it can be fatal.

Introduction

Pheochromocytoma is a rare neoplasm that originates from the adrenal medulla (Subramaniam,
2011). Production of excess catecholamine in the adrenal medulla can cause life-threatening
hypertension. It is a rare tumour, and it is a suggestion that a doctor can come across only one
such case in their entire practice years. It is a challenging condition and a fascinating one for
practitioners. If it is not diagnosed and untreated, it is fatal and life-threatening. A patient's
symptoms may mislead the clinicians, especially sweating, heart palpitations, and headaches, as
such symptoms occur in about 24% of pheochromocytoma patients (Reisch et al., 2006). With
surgery, the tumour is curable on a long-term basis. Presented is a case of a 24-year-old female
patient presenting recurring hypertension attacks and was treated successfully through open
surgical removal of pheochromocytoma.

Case Report

The female in the study, a twenty-four-year-old woman, was admitted to our hospital after
complaining of frequent attacks of heart palpitations, blurred vision, headaches, sweating, and
dizziness for the last six months. The attacks persisted for several minutes to almost half an hour
irregularly, as it would occur once within two to three days, three to four times. After a physical
examination of the patient, there were no abnormalities apart from high Blood Pressure (BP).
The BP was high during the attacks (Systolic Pressure varies from 140 to 210 mmHg and
diastolic BP ranges from 100 to 140 mmHg).

Other reports of Blood urea, blood sugar, chest X-rays, Blood count, and ECG were normal. This
led to a provisional diagnosis that the patient had secondary hypertension caused by adrenal
pheochromocytoma, but a 24-hour urinary catecholamine level had to be confirmed. Results
showed a biochemical diagnosis of pheochromocytoma. Abdominal Ultrasonography (USG)
showed a right-sided adrenal mass of 7 cm in diameter. Computed Tomography (CT) scan
showed a right-sided adrenal mass of size of about 5cm x 9 cm.

Fig. 1: USG showing right adrenal mass Fig. 2: CT scan showing right adrenal mass
After the diagnosis, we planned for surgical removal of the right adrenal gland. The patient was
prepared for surgery by giving an alpha blocker (Phenoxybenzamine) 10 days before the surgery.
The administering of the alpha-blocker was started with 10 mg 12 hourly, increasing it to 30 mg
12 hourly until the blood pressure was normal. A beta locker was also induced for five days
before surgery. This was administered 10 mg three times a day. The surgery was done on the
sixteenth day, and the last dose of drugs was administered on the morning of the day of surgery.

The surgery went well without complications. The patient was discharged eight days after the
surgery. The blood pressure was normal without any medication. The specimen taken after
histopathology confirmed that the tumour was pheochromocytoma.

Discussion

Pheochromocytoma is a rare tumour situated within the adrenal medulla. It occurs less frequently
in males than females and may also be less frequent in blacks. In terms of age, the incidence is at
its peak between thirty to forty years, but any person can get it. Statistics show that even children
are also victims. Another aspect of the tumour is that it is malignant (Grogan et al., 2011). This
will depend on the surrounding tissue. As no apparent clinical or biochemical features can
determine the malignancy of the tumour, removing the tumour as early as possible is vital.

Pheochromocytoma results from excess production of catecholamine. These symptoms are

mostly recurring episodes of headaches, palpitations, and sweating. These episodes may happen
once or several times daily, lasting from a few minutes to hours. The symptoms get worse with
time as the tumour keeps growing.

To diagnose pheochromocytoma is biochemical confirmation. A 24-hour catecholamine

collection is more sensitive compared to Plasma metanephrine testing. After biochemical
diagnosis, the next step is to use MRI or CT scan. This is for the localization of
pheochromocytoma. MRI is more sensitive than the Ct scan.

Treatment for cure is surgical removal. This is the cure of choice as it results in hypertension.
Before surgery, there should be careful planning in order to regulate blood pressure. This is done
using alpha and beta blockers (Gu et al., 2017). Phenoxybenzamine is the most preferred alpha-
blocker, while propanol is used as the beta blocker. For the operation, there should be an
experienced anesthesiologist and surgeon. Blood pressure is important to be controlled during
the surgery. A sudden fall of the BP is normal as the tumour is removed, and therefore inducing
fluids in large volumes is required. After surgery, biochemical confirmation is required to
confirm that the patient is cured of the tumour.

Conclusion

Pheochromocytoma is a cause of hypertension. It is non-discriminative as it occurs in all ages,

but the frequency differs. It has been referred to as a 10 per cent tumour. Even though it accounts
for a small percentage of the cause of hypertension, it is essential to diagnose it early not only
because of the potential cure for hypertension but also to avoid the dangers of unrecognized
tumours in the body.
References

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