Endocrine Abstracts

Introduction: PRES it’s a neurologic syndrome with multiple manifestations, that includes high blood pressure with a variable range. It usually develops in the context of medications or an underlying condition. The treatment is usually symptomatic and determined by said disease.

Objective: We present the case of a patient with PRES linked to the diagnostic of a metastatic PHEO.

Case-report: A 72-year-old male underwent left adrenalectomy in 2016, because of a PHEO. Pathology findings included capsular invasion, necrosis, diffuse focal pattern, and nuclear pleomorphism without invasion of the perinephric fat. He had no evidence of disease until 2020, when he lost follow-up because of COVID-19 pandemic. In May 2022, he was admitted in Neurology because of a hypertensive crisis up to 205/97 mmHg, headache, an acute confusional state and transient cortical blindness, that lasted hours, compatible with PRES. He was discharged with hypertensive medication. He was readmitted in June 2022 because of deterioration of general condition and weight loss up to 10 kg. Computed tomography (CT) of the chest, abdomen and pelvis was performed, showing multiple pulmonary, pleural, hepatic and bone lesions, without clear evidence of primary tumor. Because of the history of the patient and symptoms presented in the previous hospitalization, 24 h catecholamines and fractionated metanephrines urine test was determined, presented in Table 1 After the results, we initiated and titrated alpha-blockade with Doxazosin until we achieved adequate blood pressure. We completed the study with 123I-Meta-Iodobenzylguanidine Scintigraphy and Ga-68 DOTATATE PET/CT Scan which revealed increased uptake in the CT lesions. Lanreotide 120 mg sc was initiated and after nuclear imaging was performed, radionuclide therapy was also initiated, but the patient presented liver failure and died after the 1st dose of Lutetium-177.

Conclusions: Even though neurologic complications are rare, in the presence of PRES or other atypical cerebrovascular symptoms, PHEO should be suspected. PHEO should have a lifelong follow-up to prevent complications and early detection of recurrence/malignancy.