Endocrine Abstracts

We present a case of 32-year old male patient who was admitted to hospital because of newly discovered hypertension with symptoms of 4P (pain, pallor, perspiration and palpitation). During hospitalization the patient presented with polyuria, polydipsia, hyperglycemia and psychotic disorders. The suspicion of secondary hypertension was made.

Catecholamine examination test was done and revealed very high levels of adrenalin (five times more than normal), noradrenalin (20 times more than normal), vanillylmandelic acid (VMA) 2.5 times more than normal and metanephrines (10 times more than normal). The abdominal ultrasound was normal without suspicion of adrenal mass as well as abdominal CT and magnetic resonance imaging (MRI). Lung X-ray was normal. Radionuclide scintiscan after administration of the radiopharmaceutical (131-I) metaiodobenzylguanidine (MIBG), 37 mBq was done. There was pathologic accumulation of radioisotope in distal part of mediastinum. CT of thorax showed unusual deformation of left atrium. MRI of thorax discovered tumor, 6×5.5×5 cm in diameter, paravertebraly localized at the level of 9Th thoracic vertebrae which was in contact to the left atrium.

Patient was treated with phenoxybenzamine 3×60 mg orally and propranolol 3×40 mg orally 14 days prior to surgery. He was transferred to the department of cardiac surgery. At the surgery, retrocardial extirpation of pheochromocytoma was done with plastic ‘patch’ of left atrium.

Six months after surgery, metanephrines as well as vanillylmandelic acid were normal. In 2 years follow-up patient’s condition is excellent, without hypertension.