Pheochromocytoma: A Great Simulator. Small Series of A Single Institution

Abstract

Background: pheochromocytoma is a catecholamine-secreting neuroendocrine tumor, with usual origin in the adrenal medulla. They are mostly diagnosed as adrenal incidentalomas in abdominal tomography (CT) or magnetic resonance imaging (MRI) or by related symptoms, as the classic triad including headaches, profuse sweating, and palpitations. Although it is a rare cause of secondary hypertension, this occurs in a great proportion of patients and it is usually sustained and paroxysmal. The biochemical diagnosis requires the dosage of plasmatic and/or urinary metanephrines and once confirmed, an imaging study such as CT or MRI must be requested to determine its location. Pheochromocytoma usually has low metastatic potential; treatment is adrenalectomy, conventional or laparoscopic, and resection can be curative. The reason for presenting these cases is to show two forms of presentation of a rare disease, with normal or hypertension, even in large tumors. Cases: We present four cases of Pheochromocytoma, two of which were diagnosed due to secondary hypertension and two as adrenal incidentalomas. In two of them the concomitant diagnosis of panic attacks and anxiety attacks was made, which sometimes shares clinical symptoms with the clinical picture of catecholamine’s excess. A 31-year-old man presents who presented with resistant hypertension and paroxysmal adrenergic crisis. A 46-year-old woman who presented with hypertension difficult to treat and adrenal incidentaloma. A 35-year-old woman who had big adrenal incidentaloma and normal blood pressure. A 34-year-old woman developed panic attacks and was found an adrenal incidentaloma on CT without hypertension. Conclusion: pheochromocytoma is a rare tumor that can have variable clinical presentations, with low malignant potential in the majority of the cases, and its accurate treatment relays on the clinical suspicion of this entity.