Endocrine Abstracts

A 83-year-old gentleman admitted with nausea and feeling generally unwell. Past medical history of hypertension, duodenal ulcer, previous gastric surgery, polymylagia rheumatica and type two diabetes mellitus. Chest XR showed right basal pneumonia which was treated with antibiotics. Patient admitted to significant weight loss therefore he had thoracic-abdominal CT scan performed which showed 4 cm by 4 cm solid cystic lesion in the left adrenal gland possibly malignant. Subsequently magnetic resonance imaging scan revealed left adrenal heterogeneous lesion which could be either primary or metastatic. 24 h urinary metadrenaline 7.2 μmol/24 h, normetadrenaline 4.1 μmol/24 h. These findings were consistent with diagnosis of phaeochromocytoma. He had experienced hypotensive episodes associated with dizziness these were treated with intravenous fluids to expand his intravascular volume. He did not tolerate phenoxybenzamine because of dizziness and low blood pressure. He was assessed for surgical treatment to his phaeochromocytoma but in view of his multiple co-morbidity he declined surgery therefore he was managed conservatively. For nearly 2 years he remains under outpatient follow-up and his repeated imaging showed slight enlargement of his original lesion but no new lesion.

Most common symptoms of phaeochromocytoma are headaches, palpitations, sweating and tachycardia. Up to 8% of patients may be asymptomatic and are discovered incidentally on imaging done for unrelated symptoms as in our case. In the elderly decrease in baroreceptor function with age as well as concomitant disease, signs and symptoms of which can confound the paeochromocytoma diagnosis. This case clearly highlights management challenges of phaeochromocytoma in the elderly with complex co-morbidity.