PP.27.01] PHEOCHROMOCYTOMA ASSOCIATED WITH CHRONIC OR ACUTE INFLAMMATION

Abstract

Objective: Pheochromocytoma (PHEO) may present with variable symptoms and signs. In this study, we present subjects with PHEO in whom one of the leading sign was otherwise unexplainable inflammatory state (fever, elevated inflammation markers). Design and method: Retrospective analysis of subjects with PHEO. Results: Patient No. 1: 59 years old female started to suffer from fever, sweating, and abdominal pain two months before the diagnosis of PHEO. She also lost 8 kg of weight. Antibiotic treatment reduced pain, but not fever. Subsequent hospitalization showed significant elevation of inflammatory parameters and ruled out infectious origin of fever. Large adrenal mass (7 cm) was found and confirmed as PHEO. She suffered only from mild headache as PHEO-related symptom. After operation, inflammatory parameters have normalized and she has gained weight. Patient No. 2: 33 years old male suffered from recurrently elevated temperature associated with weakness at least 13 years before the diagnosis of PHEO. Elevated inflammation markers were found repeatedly and no improvement was achieved with antibiotics. Large adrenal tumor was found (12 cm) which was diagnosed as PHEO. Mild hypertension and sweating were the only PHEO-related symptoms. Three months after adrenalectomy, blood count and metanephrines have normalized. Patient No. 3: 65 years old female suffered about 6 years from diabetes mellitus and 3 years from paroxysmal headaches, sweating, and vomiting. Emergency was called due to chest pain, vomitus and dyspnea. She was admitted to ICU with elevated blood pressure (220/110 mmHg) and diagnosis of takotsubo cardiomyopathy was made. Clinical course was complicated with profound hypotension and fever up to 41°C. On CT scan, smaller adrenal tumor (4 cm) was found. All examinations ruled out infectious origin of hyperpyrexia and diagnosis of PHEO was confirmed. Her condition improved completely within days and she was scheduled for adrenalectomy free of any symptoms. After operation, she reports no paroxysmal symptoms, and weight gain of 6 kg.Conclusions: Catecholamine elevation in PHEO usually leads to very mild elevation of markers of inflammation. In these subjects, clinical course of PHEO was modified with clinical picture of severe inflammation.