Endocrine Abstracts

Introduction: Pheochromocytomas are rare neuroendocrine tumors arising from chromaffincells of the adrenal gland or extra-adrenal paragangliomas. These tumors cause a hypersecretion of catecholamines, resulting in high blood pressure (HBP) and eventual cardiovascular complications. The point of this study is to go through the different clinical aspects of high blood pressure related to pheochromocytomas.

Methods: This is a retrospective study about 8 patients, hospitalized in the internal medicine department in Mahdia, having suffered from a HBP due to a pheochromocytoma , on a period of 13 years.

Results: The study concerned 4 women and 4 men with a mean age of 47.3 years old (33–64). The circumstances under which the pheochromocytoma was discovered, were adrenal incidentaloma in 4 cases and a paroxysmal HBP with adrenergic symptoms in the 4 others. A history of HBP was found in 3 patients. A grade 3 HBP was found in 7 patients with systolic hypertensive peaks reaching 250 mmHg. One out of these 8 patients had a cardiomyopathy and a hypertensive retinopathy due to HBP. The diagnosis of pheochromocytoma was made based on elevated levels of metanephrines in urine in 7 patients and in blood in one patient. CT scanning localized the tumor in 7 patients, while the eighth required an MIBG scan. The tumor was localized in the left adrenal gland in 4 cases , in the right adrenal gland in 3 cases , while an ectopic localization was found in one patient, precisely in the inferior pole of the right kidney. The mean size of the pheochromocytoma was 6.3 cm [3.6–9.8 cm]. The search for a multiple endocrine neoplasia came back negative. All the patients underwent surgery, consisting of a unilateral adrenalectomy in 7 patients. The evolution was marked by the regression of the adrenergic signs and the normalisation of blood pressure without resorting to a medical treatment.

Conclusion: Pheochromocytoma is a rare cause of HBP. The diagnosis must be suspected when faced with a severe paroxysmal HBP, with hypertensive peaks and especially when associated with adrenergic signs. Its diagnosis is based on the measuring of metanephrines in urine or in blood. The surgical treatment may heal HBP.