Endocrine Abstracts

Case 1: A 65 year-old lady presented to ED with chest pain and collapse. Her PMH includes hypothyroidism and gastritis.

Results and management: Her ECG was normal. Her troponin levels were raised at 48 and 70.6. CTPA which was requested as her D-dimer was high (1034), showed no PE but showed hypodense lesions in liver. In view of this, CT TAP was done which showed benign liver cysts, and a 2.6 cm adrenal mass. She was treated for ACS. Her ECHO and Angiogram were unremarkable. No clear underlying cause for her ACS was identified and was concluded that she had probable Type 2 MI secondary to cardiac arrthymia. Cardiac MRI showed a small inferolateral wall infarction. Further adrenal workup showed raised plasma metanephrine of 1249 pmol/l (Normal:<510 pmol/l), and plasma normetanephrine of 1456 pmol/l (Normal: <1180 pmol/l). CT adrenals showed benign right adrenal adenoma. MIBG scan showed right adrenal phaeochromocytoma. Subsequently she underwent laparoscopic right adrenalectomy.

Case 2: Whilst awaiting investigations for a right adrenal incidentaloma, a 76-year-old gentleman admitted to ITU following out of hospital cardiac arrest. His PMH includes hypertension and hyperlipidaemia.

Results and management: His ECG was unremarkable apart from old RBBB. His bedside ECHO was normal. CT PA showed no evidence of PE. His troponin was raised at 109 which subsequently normalised. No clear underlying cause for his cardiac arrest was identified. Adrenal workup showed raised plasma metanephrine of 548 pmol/l (Normal:<510 pmol/l) and plasma normetanephrine of 1724 pmol/l (Normal:<1180 pmol/l). MIBG scan showed 3.4cm right adrenal phaeochromocytoma. He later underwent laparoscopic right adrenalectomy.

Discussion: Phaeochromocytoma is a rare cause of secondary hypertension and cardiac complications. No clear cause has been identified for the acute presentations apart from phaeochromocytoma in our patients. Our cases illustrate the need for considering phaeochromocytoma in patients presenting with unexplained cardiac emergencies.