Endocrine Abstracts

A 72-year-old man known to have Churg-Strauss syndrome, Type 2 diabetes mellitus, hypertension and asthma presented with history of polyuria, night sweats, weight loss of 6 kg over 8 weeks and poor mobility. Pulse rate was 88/min and blood pressure 131/74 mmHg. He had generalised muscle wasting with significant proximal myopathy and grade 4/5 power in all four limbs. There was no evidence of vasculitis, arthropathy or other neurological deficit. Blood tests showed urea 10.6 mmol/l and creatinine 113 μmol/l. ESR, calcium, liver function, thyroid function tests, antinuclear, antimitochondrial, antismooth muscle, antiparietal cell antibodies, ANCA, myeloperoxidase, PR3 antibodies, CK, tumour markers, serum protein electrophoresis, were normal. HBA1C was 7.1%. He had glycosuria, but no protein or blood in urine. Lumbar puncture showed slightly elevated protein, EMG was suggestive of diabetic amyotrophy and MRI of thoracolumbar spine showed degenerative changes. Serologic tests for tuberculosis, lyme disease and syphilis were negative.

CT scan of chest, abdomen and pelvis and subsequent MRI scan showed a 3×2 cm lesion in the left adrenal gland. Twenty-four hour urine collections on three occasions showed elevated noradrenaline 3.47, 2.80, 3.15 (normal 0.07–0.48 μmol/24 h), adrenalin 0.11, 0.17, 0.14 (normal up to 0.1 μmol/24 h) normetadrenalin 9.3, 7.8, 7.8 (normal up to 3 μmol/24 h) and metadrenalin 2.2, 1.7, 1.9 (normal upto1.4 μmol/l). MIBG scan showed increased uptake suggestive of left adrenal phaeochromocytoma.

He was started on phenoxybenzamine, and underwent laproscopic adrenalectomy with histology confirming adrenal phaeochromocytoma. He made good recovery from myopathy, regaining good mobility. His three antihypertensive agents were discontinued and he remained normotensive.

Although catecholamine induced cardiomyopathy is well known, significant myopathy as a presentation of phaechromocytoma with rapid improvement after surgery, has not been reported in literature the past.