A Case of Pheochromocytoma Revealed by an Etonogestrel Contraceptive Implant Use

Abstract

Background: Pheochromocytoma (PH) is a rare tumor developed at the expense of the adrenal medulla and secreting catecholamines. It is also a rare cause of curable hypertension in adults. Case information: We reported a case of PH in a 39-year-old Malagasy woman, with no particular history. The clinic was dominated by the onset of paroxysmal hypertension associated with headache, palpitations, and sweating. Its clinical manifestations were revealed by the insertion of an etonogestrel contraceptive implant. Despite the removal of the contraceptive implant and the taking of an antihypertensive drug based on a calcium channel blocker, the hypertension persisted with a paroxysmal character and always associated with the Menard triad. Results: The diagnosis was made against the elevation of urinary metanephrines and normetanephrines and the presence of a heterogeneous left adrenal mass on computed tomography. Surgical resection of the tumor made it possible to perform an immunohistochemical examination confirming the diagnosis. Without surgical complications, the patient's blood pressure as well as urinary metanephrine and normetanephrine, normalized without taking any antihypertensive drug. Conclusion: Hormonal contraception could be wrongly blamed the cause of hypertension. Then she would just be a triggering factor. Thus, any atypical hypertension following the use of a hormonal contraceptive must encourage the search for a secondary cause such as PH.