ECE2015 Eposter Presentations Clinical Cases–Pituitary/Adrenal (95 abstracts)
Intestinal obstruction and bowel perforation as a presenting feature of a phaeochromocytoma
Izaskun Olaizola 1 , Estela Elias 2 , Ana Maria Chacon 1 , Ismene Bilbao 1 , Nerea Egaña 1 , Cristina Garcia 1 , Maite Aranburu 1 , Tomas Matteucci 2 , Alfredo Yoldi 1 & Miguel Goena 1
1Hospital Universitario Donostia, Donostia San Sebastián, Gipuzkoa, Spain; 2Hospital Bidasoa, Irún, Gipuzkoa, Spain.
Introduction: Phaeocromocytomas are a rare catecholamine secreting tumours that can present in multiple ways. The classic triad of symptoms consists of episodic headache, sweating, and tachycardia. Most patients do not have the three classic symptoms. Sustained or paroxysmal hypertension is the most common sign. Among less common symptoms and signs constipation has been described and few cases of megacolon and phaeochromocytoma have been published.
Case report: A 39 year-old man, with previous medical history of schizophrenia, autism and pulmonary tuberculosis with a partial left lobectomy, complained of abdominal pain of 3 days. An abdominal X-ray demonstrated dilated loops of small and large bowel with air-fluid levels in the upright position, abundant faecal remainders in the large bowel and faecaloma. Large bowel obstruction was suspected presenting an unfavorable evolution despite medical treatment. CT scan showed small and large bowel obstruction secondary to an intestinal malrotation with signs of sigmoid colon and rectum suffering and a left adrenal incidentaloma of 6 cm. An urgent surgical intervention was performed showing small bowel obstruction secondary to internal hernia secondary to dolichomegasigma and large bowel perforation with loculated abscess, performing sigmoidectomy, terminal colostomy and abscess exeresis. The postoperative evolution was good. The functionality of the adrenal incidentaloma was studied showing urinary metanephrines consistent with phaeochromocytoma. Treatment with phenoxybenzamine was started and left adrenalectomy was performed confirming the diagnosis of phaeochromocytoma. 1 year after the surgery he has not presented new episodes of bowel obstruction.
Conclusions: Intestinal obstruction is an important clinical condition that can present in association of phaeochromocytoma. Due to the risk of intervention in a patient previously not treated with alpha-blockade, if an adrenal incidentaloma is observed in a patient with intestinal obstruction, phaeochromocytoma should be ruled out in order to prevent. surgery complications.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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