| Nonclassic presentation of pheochromocytoma: difficulties in diagnosis and management of the normotensive patient. | |
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MedLine Citation:
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PMID: 18558602 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To report an unusual presentation of pheochromocytoma along with challenges in diagnosis and management. METHODS: We report a clinical case history and describe diagnostic methods and pitfalls. The preoperative medical preparation in a normotensive patient is described. RESULTS: A 33-year-old man fell off a ladder, resulting in C6 paraplegia. After C7-T1 laminectomy, he was transferred to a rehabilitation center where he reported lightheadedness, shortness of breath, and chest pain during therapy sessions. A left adrenal mass was incidentally discovered during the workup to rule out a pulmonary embolism. He reported no history of hypertension, and no elevated blood pressure readings had been documented. Magnetic resonance imaging of the adrenal glands showed a well-defined left adrenal mass measuring 3.9 x 3.2 x 3.3 cm, which was hyperintense on T2-weighted images. Twenty-four hour urinary catecholamine concentrations were unremarkable; urinary metanephrines were markedly elevated. During hospital admission, blood pressure was in the low to normotensive range, requiring a cautious approach to alpha-adrenergic blockade and surgical preparation. He under-went uneventful laparoscopic left adrenalectomy; surgical pathology was consistent with pheochromocytoma. CONCLUSIONS: This case illustrates a nonclassic presentation of pheochromocytoma and demonstrates that urinary catecholamines alone are not sufficient for a biochemical diagnosis of large pheochromocytomas. Preoperative preparation in normotensive patients can be achieved with alpha-adrenergic blockade, hydration, and liberal salt intake. |
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Authors:
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Adalberto D Gonzalez-Pantaleon; Barbara Simon |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Volume: 14 ISSN: 1934-2403 ISO Abbreviation: Endocr Pract Publication Date: 2008 May-Jun |
Date Detail:
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Created Date: 2008-06-18 Completed Date: 2009-01-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9607439 Medline TA: Endocr Pract Country: United States |
Other Details:
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Languages: eng Pagination: 470-3 Citation Subset: IM |
Affiliation:
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Division of Endocrinology and Diabetes, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Gland Neoplasms
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diagnosis*,
surgery*,
urine Adult Catecholamines / urine Humans Magnetic Resonance Imaging Male Pheochromocytoma / diagnosis*, surgery*, urine |
| Chemical | |
Reg. No./Substance:
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0/Catecholamines |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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