Endocrine Abstracts

Pheochromocytoma is an uncommon tumour found in the adrenal gland medulla. It is identified by the excessive release of catecholamines. The typical symptoms include paroxysms of high blood pressure and adrenergic symptoms like headaches, sweating, breathlessness, and palpitation. In severe instances, patients may experience hypertensive crises and cardiomyopathy. We describe a case where intestinal pseudo-obstruction, a rare complication of pheochromocytoma, was only resolved through surgical removal of the tumour. A 76-year-old woman presented to the Emergency Department with worsening shortness of breath, chest discomfort, and collapsing after starting a new beta blocker medication. Initial evaluation showed tachypnoea, low oxygen saturation, and high blood pressure. A CT pulmonary angiogram ruled out a pulmonary embolism but unexpectedly detected an 8-centimeter lesion on her right adrenal gland, highly suggestive of pheochromocytoma. Additional imaging with CT scans of the chest, abdomen, and pelvis, along with elevated urinary metanephrines, confirmed the diagnosis of non-metastatic pheochromocytoma. During her hospital stay, the dosage of Doxazosin was gradually increased to the maximum amount, yet her blood pressure remained uncontrolled, and she began experiencing symptoms of bowel obstruction. A CT scan of the abdomen revealed a non-mechanical small bowel obstruction, confirming a diagnosis of paralytic ileus. She was placed on nothing by mouth (NBM) and transferred to the Intensive Care Unit (ICU) for intravenous Phentolamine infusion, but her paralytic ileus continued to worsen. Consequently, she underwent an urgent laparoscopic right adrenalectomy, which successfully resolved the paralytic ileus and allowed for a gradual discontinuation of her antihypertensive medications. In conclusion, this case highlights the uncommon complications of pheochromocytoma, such as intestinal pseudo-obstruction, which should be considered during acute presentations. Early recognition and appropriate management are crucial in addressing these rare complications effectively.