LBSAT62 Incidental Diagnosis Of Pheochromocytoma With Left Ventricle Hypertrophy And Bradycardia In A Normotensive Patient

Abstract

Abstract Introduction Pheochromocytoma is a rare catecholamine secreting tumor. It can be associated with multiple endocrine neoplasia type 2(MEN 2), neurofibromatosis type 1 and von hippel-lindau syndromes(1). Case 36 year old afro american male with no pervious medical or surgical history. Drinks alcohol occasionally. no regular medications or known allergies. Family history is positive for mother with hypertension. He was referred to endocrinology clinic after incidental finding of a left adrenal mass in CT scan. The CT abdomen and pelvis with contrast showed heterogenous enhancing mass in the left adrenal gland of 5.5×4.1×5.3centimeters compressing the anterior margin of left kidney with necrotic and cystic foci. Review of systems was negative, denied headache,palpitations, seizure, sweating and weight loss. Physical examination was remarkable for bradycardia with heart rate of 50BPM. Laboratory work up was significant for high plasma metanephrine 2070 pg/ml normal less than 88, normetanephrine 1983pg/ml normal less than 110, chromogranin A 1259ng/ml normal less than 101.8, 24hr urine metanephrine 13342ug/24hr normal between 58 and 276 and 24hr urine normetanephrine 6596 ug/24hr normal between 156 and729. Thrombocytosis and macrocytic RBCs.12 Lead electrocardiogram showed sinus bradycardia 50BPM with left ventricle hypertrophy Sokolow-Lyon criteria. MRI abdomen showed 4.9×3.8×5.3 centimeters solid mass in the left adrenal gland. MIBG Scan showed intense radiotracer accumulation in the left adrenal gland. He was kept on alpha blockers for three weeks and beta blocker was added in the last week with intravenous fluids on the day of surgery. He underwent uneventful left laparoscopic adrenalectomy. Histopathology showed a 6cm focal non neoplastic pheochromocytoma in the left adrenal gland with negative surgical margins. Genetic test for MEN2A/B-RET was negative. Conclusion pheochromocytoma has a variable clinical presentations. The classis triad of episodic headache, sweating and palpitations is infrequent. It can present with electrocardiogram changes of left ventricle hypertrophy without high blood pressure. Rare cases have bradycardia. The secreted interleukins and inflammatory markers can cause thrombocytosis. Treatment is surgical resection with preoperative alpha and beta blockage. Long term follow up is recommended for the recurrence(2).