Endocrine Abstracts

Phaeochromocytoma is a rare tumour of the adrenal gland medulla characterized by excess catecholamine release. Classic presentation includes paroxysms of hypertension and adrenergic symptoms such as headache, sweating, shortness of breath, and tachycardia. In severe cases, patients might develop hypertensive crises and cardiomyopathy. We present a case of intestinal pseudo-obstruction as a rare complication of phaeochromocytoma which responded only to surgical resection of the tumour. A 76-year-old lady presented to A&E with progressive shortness of breath, chest discomfort, and collapse following a new introduction of a beta blocker. Initial assessment revealed tachypnoea, low oxygen saturation, and high blood pressure. CT pulmonary angiogram ruled out pulmonary but picked up incidental 8-cm right adrenal lesion, highly suspicious for phaeochromocytoma. Further imaging with CT thorax, abdomen and pelvis and raised urinary metanephrines confirmed non-metastatic phaeochromocytoma diagnosis. During admission, Doxazosin was titrated up to the maximum dose; however, blood pressure remained uncontrolled while she started to develop symptoms of bowel obstruction. CT abdomen revealed non-mechanical small bowel obstruction which confirmed paralytic ileus diagnosis. She was put on NBM and moved to ICU for IV Phentolamine infusion; however, paralytic ileus continued to deteriorate. Accordingly, she underwent urgent laparoscopic right adrenalectomy which managed to resolve paralytic ileus and allowed her to gradually stop antihypertensive medications. In conclusion, this case sheds light on rare complications of phaeochromocytoma, including intestinal pseudo-obstruction, that should be assessed in acute presentations.