Endocrine Abstracts

Presence of clinical symptoms and signs specific for suspected illness is, in general, a condition sine qua non to start diagnostics procedures. However, some diseases may proceed with various and disparate symptoms, which often suggests completely different diagnosis. One of them is pheochromocytoma – rare, usually benign neoplasm derived from chromaffin cells of adrenal medulla. It is very important to diagnose the disease while it is curable by surgery like many tumors but the appropriate premedication is necessary to carry out a successful operation. Unfortunately, the rarity, unspecific symptoms and extremely variable imaging phenotype render the investigation for these tumors very hard. The diagnose of pheochromocytoma is often made too late, and that may be very dangerous for patients. To prove this, we present several patients with completely different course of the disease.

Case 1: ‘Classic’ clinical features (hypertensive paroxysms with tachycardia and sweating) in 48-yr old women with big, high density tumour in left adrenal gland.

Case 2: Paroxysms of sweating and worsening of circulatory insufficiency, without hypertension in 71-yr old women with heterogenic left adrenal mass with signs of bleeding inside.

Case 3: Acute back pain in 50-yr old man with nephrolithiasis and normal blood pressure.

Case 4: Postural hypotension in 62-yr old man with incidentaloma of the right adrenal gland.

Case 5: Panic attacks in 35-yr old woman with 5-cm tumour in right adrenal gland. We analyse clinical sings and symptoms, imaging features (CT, MRI, MIBG), results of biochemical and hormonal investigations of such cases.