A Pheochromocytoma in an Elite Collegiate Athlete

Abstract

HISTORY: A 22-Year-old rugby union player presented to the Sports Medicine clinic complaining of a sore throat and skin rash over his back and upper arms for the past week. Further symptoms included rhinorrhoea and dry cough for the previous week, feeling “hot” (especially at night) and constant fatigue. The occurrence of these symptoms coincided with a regional measles outbreak. The clinical symptomatology persisted at subsequent visits over a period of 12 months and ranged from diarrhoea, skin rash, dry cough, headaches, anxiety, night sweats, rapid heart rate and exercise intolerance. Despite follow-up visits when he was asymptomatic, constant weight loss occurred over the period since he first presented. Except for weight loss and a single blood pressure reading of 135/90mmHg previously his medical history was uncompromized. He had a history of various sport related musculoskeletal injuries and there was no family history of note. PHYSICAL EXAMINATION: At initial physical examination athlete was afebrile, HR 100 b/min with a blood pressure reading of 110/60mmHg. Palpable tender occipital lymph nodes were present. Except for the non-purulent pharyngitis and maculopapular rash over the back and upper arms, the remainder of systemic physical examination was normal. Although normal or low BP measurements were recorded occasionally, he remained tachycardic and BP mildly elevated (135/90 mmHg) with the skin rash located over the trunk at most visits. DIFFERENTIAL DIAGNOSIS: Viral infection (measles, rubella, coxaci, EBV), Viral infection unspecified, Hyperthyroidism, Pulmonary tuberculosis, Vasomotor response to immune activation, Essential Hypertension, Pheochromocytoma. TEST AND RESULTS: FBC’s-normal, ESR-normal, CRP-normal, Rubella/Measles IGM (-), s-Urea (7.7mmol/L), s-Creatinine (108μmol/L), S-ALKP (136μmol/L), s-GGT (140μmol/L), S-ALT (101μmol/L), Coxaci-B AB (+), EBV (+), U-VMA-24hrs (50112 nmol/L), MIBG Scan negative (left) indicated a left adrenal gland mass, CT Abd (Triphasic)-well defined mass left adrenal gland FINAL WORKING DIAGNOSIS: Benign pheochromocytoma-left adrenal gland TREATMENT AND OUTCOMES: Laparoscopic adrenalectomy (left), Uncomplicated post operative recovery,Full return to sport