Endocrine Abstracts

Introduction: Pheochromocytomas represent rare but potential lethal tumors arising from the adrenal medulla. Early recognition and diagnosis represent a challenge due to the non-specific character of signs and symptoms. The classic presentation includes headache, sweating, palpitations and other signs and symptoms of apparent catecholamine excess occurring in paroxysms. Sympathomimetics may result in a similar presentation, potentially complicating the diagnosis.

Clinical case: We report the case of a 35-year old male with a 17-year history of drug addiction. For a long time, he complained of daily short spells of severe headache, nausea, vomiting, profuse sweating, palpitations, pallor, anxiety, tremor and constipation that were present even though the patient claimed to have given up his amphetamine addiction 18 months before referral to our clinic. During that 18-month period the patient was prescribed escitalopram, which was reported to amplify the intensity of symptoms. The patient was without a history of hypertension or other comorbidities but reported lumbar pain and digestive complaints. Due to the latter complaints, his general practitioner performed an ultrasound, which revealed a large mass in the region of the right adrenal. A 5 cm adrenal mass was confirmed by magnetic resonance imaging and the patient was referred to the Departments of Urology for adrenalectomy and Endocrinology to exclude hormonal activity. Twenty-four-hour blood pressure monitoring revealed episodic hypertension, tachycardia, and no nocturnal dipping, while biochemical testing revealed a plasma metanephrine of 2111 pg/ml (N<84 pg/ml) and normetanephrine of 701 pg/ml (N<125 pg/ml). This was interpreted as unlikely to reflect amphetamine abuse. The tumor was confirmed after surgical resection by pathology. All signs and symptoms were resolved after adrenalectomy.

Discussion: In this patient, the almost complete constellation of typical signs and symptoms of a catecholamine-producing tumor was possibly ignored for some time due to the long history of amphetamine abuse. The presence of the tumor was only discovered incidentally due to abdominal complaints. It is unlikely that the persistent signs and symptoms were due to continued use of methamphetamine since all signs and symptoms completely resolved after removal of the tumor.