Abstract
Introduction: Pheochromocytoma is a generally benign neoplasm derived from chromaffin cells of the adrenal medulla. It is characterized by the production of large amounts of catecholamines and also by the capacity to secrete bioactive peptides such as cytokines, mainly interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF alpha.Case presentation: 24-year-old man, who consulted for fever, myalgia, and choluria. His laboratory tests were compatible with a systemic inflammatory response without infectious or autoimmune causes. However, a fluorodeoxyglucose positron emission tomography (FDGPET) revealed a left adrenal mass, without extra-adrenal lesions. On admission, increased levels of differentiated urine methanephrines, elevated baseline cortisol, non-suppressed adrenocorticotrophic hormone (ACTH), and positive low dose dexamethasone suppression test for cortisol were found. With suspicion of catecholamine and ACTH-producing pheochromocytoma, a tumor resection was performed, which conspicuously resolved all alterations of the inflammatory response. The histologic findings confirmed a pheochromocytoma, but the immunostaining for ACTH was negative. A literature review and the comparison of the findings with other reported cases allowed inferring that this was a case of interleukin-producing pheochromocytoma.Conclusion: Pheochromocytoma may be a cause of febrile syndrome, with IL-6 being the main mediator, which explains the manifestationsof systemic inflammation and ACTH-mediated hypercortisolism.
Highlights
Pheochromocytoma is a generally benign neoplasm derived from chromaffin cells of the adrenal medulla
It is characterized by the production of large amounts of catecholamines and by the capacity to secrete bioactive peptides such as cytokines, mainly interleukin-1 IL-1, interleukin-6 IL-6 and TNF alpha
Pheochromocytoma may be a cause of febrile syndrome, with IL-6 being the main mediator, which explains the manifestations of systemic inflammation and adrenocorticotrophic hormone (ACTH)-mediated hypercortisolism
Summary
Pheochromocytoma is a generally benign neoplasm derived from chromaffin cells of the adrenal medulla. El sujeto presentó laboratorios compatibles con respuesta inflamatoria sistémica sin causa infecciosa o autoinmune y estudio de tomografía por emisión de positrones con fluorodesoxiglucosa que evidenció masa suprarrenal izquierda sin lesiones extra-adrenales. Se sospechó diagnóstico de feocromocitoma productor de catecolaminas y ACTH, por lo que se llevó a resección tumoral, con lo cual, llamativamente, se resolvieron todas las anomalías de respuesta inflamatoria. Case presentation: 24-year-old man, who consulted for fever, myalgia, and choluria His laboratory tests were compatible with a systemic inflammatory response without infectious or autoimmune causes. El feocromocitoma puede ser una causa de síndrome febril, siendo la IL-6 el mediador principal que explicaría las manifestaciones de inflamación sistémica y el hipercortisolismo mediado por ACTH
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