Intracerebral Hemorrhage as the Presenting Feature of Concurrent Pheochromocytoma and Paragangliomas

Abstract

all had a pheochromocytoma diagnosed.A careful search of the literature, however, hasnot revealed a case of ICH caused by concurrentpheochromocytoma and paraganglioma tumors ina young adult requiring more than one surgicalintervention.CASE REPORTA 25-year-old woman presented with a suddenonset of dysarthria and right-sided hemiparesis.Brain computed tomography and magnetic reso-nance imaging revealed hemorrhage of the leftbasal ganglia (Figure 1). Her supine blood pressurewas 240⁄130 mm Hg, with a heart rate of 96 beatsper minute. Renal function was normal (serumurea, 27 mg ⁄dL; serum creatinine, 0.71 mg ⁄dL;and negative urinalysis results), and routine labora-tory test findings were within normal limits. Resultsof chest radiography were negative, 12-lead electro-cardiography revealed sinus rhythm with no signsof hypertrophy, and 2-dimensional Doppler echo-cardiography showed a left ventricular ejectionfraction of 70% with mild hypertrophy (interventri-cular septal-diastole, 12.3 mm; left ventricular pos-terior wall-diastole, 13.0 mm).The patient had had paroxysmal attacks ofsevere headaches and tachycardia over a 5-year per-iod, without any other illnesses; blood pressure wasnever measured during these attacks. The suddenonset of severe hypertension in addition to hermedical history raised suspicion of secondaryhypertension and especially pheochromocytoma.Computed tomography and magnetic resonanceimaging of the abdomen revealed an enlarged rightadrenal gland and a rounded mass in proximity tothe upper pole of the left kidney (Figure 2). Thepatient was referred to our hospital.In order to establish the diagnosis of pheochro-mocytoma, biochemical and radiologic studies wereperformed. Urinary catecholamine levels wereincreased (908 lg⁄24 h; reference values <150lg⁄24 h) and plasma noradre naline levels were alsohigh (noradrenaline, 3461 pg ⁄mL; references values<450 pg⁄mL); these were not suppressed by cloni-dine. Scintigraphy with