Pheochromocytoma in an elderly patient (case report)

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Abstract

Background: Timely diagnosis of pheochromocytoma (PCC) is difficult due to the rare occurrence of this pathology (1:200,000 population) and variability of clinical symptoms. One of the manifestations of PCC is arterial hypertension (AH), which can be either paroxysmal in nature or manifest as persistent AH resistant to antihypertensive therapy.

Description of the clinical case: The article considers the clinical case of an elderly patient who, despite typical complaints for FCC and therapy-resistant hypertension, was followed-up for a long time with a diagnosis of arterial hypertension (AH). This led to uncontrolled hypertension and the development of acute cerebrovascular accident (ACVA). For the first time, the diagnosis of FCC was suspected during the treatment of COVID-19 after chest multispiral computed tomography (chest MSCT) and the detection of a formation in the left adrenal gland. Surgical removal of FCC led to normalization of blood pressure (BP) in the postoperative period without taking any antihypertensive drugs.

Conclusion: The presented clinical case shows the importance of the earliest possible diagnosis of FCC in patients with therapy-resistant hypertension in order to avoid the development of serious complications, including ACVA. The article summarizes the current recommendations for the diagnosis of pheochromocytoma, which suggest the determination of blood or urine methylated catecholamine levels (metanephrine, normetanephrine) as specific markers of this disease as first-line diagnostic tests.

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About the authors

L. Yu. Khamnueva

Irkutsk State Medical University

Email: gryaznova_81@inbox.ru
ORCID iD: 0000-0001-6296-898X
SPIN-code: 4933-3080

Department of Endocrinology and Clinical Pharmacology

Russian Federation, Irkutsk

L. S. Andreeva

Irkutsk State Medical University

Email: gryaznova_81@inbox.ru
ORCID iD: 0000-0003-4687-0004
SPIN-code: 2221-7452

Department of Endocrinology and Clinical Pharmacology

Russian Federation, Irkutsk

Maria A. Gryaznova

Irkutsk State Medical University

Author for correspondence.
Email: gryaznova_81@inbox.ru
ORCID iD: 0009-0007-6631-6138
SPIN-code: 9760-9435

Cand. Sci. (Med.), Teaching Assistant, Department of Endocrinology and Clinical Pharmacology

Russian Federation, Irkutsk

E. A. Danilova

Irkutsk Order of the Badge of Honor Regional Clinical Hospital

Email: gryaznova_81@inbox.ru
Russian Federation, Irkutsk

A. G. Basayeva

Irkutsk State Medical University

Email: gryaznova_81@inbox.ru

Department of Endocrinology and Clinical Pharmacology

Russian Federation, Irkutsk

References

  1. Lenders J.W., Duh Q.Y., Eisenhofer G. et al. Endocrine Society. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014 Jun;99(6):1915–42. doi: 10.1210/jc.2014-1498.
  2. Lenders J.W.M., Kerstens M.N., Amar L. et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020 Aug;38(8):1443-1456. doi: 10.1097/HJH.0000000000002438.
  3. Aygun N., Uludag M. Pheochromocytoma and paraganglioma: from epidemiology to clinical fi ndings. Sisli Etfal Hastan Tip Bul. 2020;54(2):159–168. doi: 10.14744/SEMB.2020.18794.
  4. Santos P., Pimenta T., Taveira-Gomes A. Hereditary Pheochromocytoma. Int J SurgPathol. 2014 Aug;22(5):393–400. doi: 10.1177/1066896914537683.
  5. Ilias I., Pacak K. A clinical overview of pheochromocytomas/paragangliomas and carcinoid tumors. Nucl. Med. Biol. 2008;35(l):S27–S34. doi: 10.1016/j.nucmedbio.2008.04.007.
  6. Manger W.M., Gifford R.W. Pheochromocytoma. J Clin Hypertens (Greenwich). 2002 Jan-Feb;4(1):62–72. doi: 10.1111/j.1524-6175.2002.01452.x.
  7. Beltran S., Pharel M., Montgomery C.T. et al. Food insecurity and hypertension: A systematic review and meta-analysis. PLoS One. 2020; Nov 17;15(11):e0241628. doi: 10.1371/journal.pone.0241628.
  8. Groeben H., Walz M.K., Nottebaum B.J. et al. International multicentre review of perioperative management and outcome for catecholamine-producing tumours. Br J Surg. 2020;107(2):e170–e178. doi: 10.1002/bjs.11378.
  9. Эндокринология: национальное руководство. Под ред. И.И. Дедова, Г.А. Мельниченко. 2-е изд., перераб. и доп. Москва: ГЭОТАР-Медиа, 2021. 1112 с.: ил. [Endocrinology: national guidelines. Edited by I.I. Dedov, G.A. Melnichenko. 2nd ed., revised and enlarged. Moscow: GEOTAR-Media, 2021. 1112 p.: ill. (In Russ.)].
  10. Pacak K. Newbiology of pheochromocytoma and paraganglioma. Endocr Pract. 2022;28(12):1253–1269. doi: 10.1016/j.eprac.2022.09.003.
  11. Grigoryan S., Nhan W., Zhang L. et al. Rates of Pheochromocytoma/Paraganglioma Screening in At-Risk Populations. J Clin Endocrinol Metab. 2023 May 17;108(6):e343–e349. doi: 10.1210/clinem/dgac701.
  12. Нейроэндокринные опухоли. Клинические рекомендации, 2020. [Neuroendocrine tumors. Clinical guidelines, 2020. (In Russ.)]. URL: https://cr.minzdrav.gov.ru/view-cr/610_1
  13. Guo J., Qiu Y., Zhang X. et al. Unexpected pheochromocytoma leading to cardiac arrest during the perioperative period: a case report and literature review. BMC Anesthesiol. 2024 Dec 19;24(1):463. doi: 10.1186/s12871-024-02850-w.
  14. Faryal J., Rajkanna J., Oyibo S.O. An Incidental Finding of a Large Pheochromocytoma in an Asymptomatic Male: A Case Report. Cureus. 2024 Dec 13;16(12):e75659. doi: 10.7759/cureus.75659.
  15. Ackfeld T., Beuret H., Mosar F., Cook S. Phaeochromocytoma mimicking acute ST-elevation myocardial infarction. BMJ Case Rep. 2024 Dec 15;17(12):e263311. doi: 10.1136/bcr-2024-263311.
  16. Calçada A., Costa V., Lêdo L., Freire P. Quick action required: revealing pheochromocytoma as the hidden trigger behind postoperative hypertensive crisis. J Hypertens. 2025 Jan 1;43(1):173–176. doi: 10.1097/HJH.0000000000003882.
  17. Eisenhofer G., Prejbisz A., Peitzsch M. et al. Biochemical Diagnosis of Chromaffin Cell Tumors in Patients at High and Low Risk of Disease: Plasma versus Urinary Free or Deconjugated O-Methylated Catecholamine Metabolites. Clin Chem. Nov 2018;64(11):1646–1656. doi: 10.1373/clinchem.2018.291369.
  18. Neumann H.P., Young W.F., Krauss T. et al. 65 Years of the DOUBLE HELIX: Genetics informs precision practice in the diagnosis and management of pheochromocytoma. Endocr Relat Cancer. 2018 Aug;25(8):T201-T219. doi: 10.1530/ERC-18-0085.
  19. Constantinescu G., Langton K., Conrad C. et al. Glucocorticoid Excess in Patients with Pheochromocytoma Compared with Paraganglioma and Other Forms of Hypertension. J Clin Endocrinol Metab. 2020 Sep 1;105(9):e3374–83. doi: 10.1210/clinem/dgaa423.
  20. Иванушко М.А., Ворохобина Н.В., Великанова Л.И., Шафигуллина З.Р. Особенности метаболизма глюкокортикоидных гормонов у пациентов с феохромоцитомой. Вестник Северо-Западного государственного медицинского университета имени И.И. Мечникова. 2017;9(3):59–64. [Ivanushko M.A., Vorokhobina N.V., Velikanova L.I., Shafigullina Z.R. Characteristics of metabolism of glucocorticoid hormones in patients with pheochromocytoma. Herald of the Northwestern State Medical University named after I.I. Mechnikov. 2017;9(3):59–64. (In Russ.)].
  21. Ehrhart-Bornstein M., Bornstein S.R. Cross-talk between adrenal medulla and adrenal cortex in stress. Ann N Y Acad Sci. 2008;1148(1):112–117. doi: 10.1196/annals.1410.053.
  22. Ehrhart-Bornstein M., Hinson J.P., Bornstein S.R. et al. Intraadrenal interactions in the regulation of adrenocortical steroidogenesis. Endocr Rev. 1998;19(2):101–143. doi: 10.1210/edrv.19.2.0326.
  23. Schinner S., Bornstein S.R. Cortical-chromaffin cell interactions in the adrenal gland. Endocr Pathol. 2005;16(2):91–98. doi: 10.1385/ep:16:2:091.
  24. Wolf K.I., Santos J.R.U., Pacak K. Why Take the Risk? We Only Live Once: The Dangers Associated with Neglecting a Pre-Operative Alpha Adrenoceptor Blockade in Pheochromocytoma Patients. Endocr Pract. Jan 2019;25(1):106–108. doi: 10.4158/EP-2018-0455.
  25. Мельниченко Г.А., Трошина Е.А., Бельцевич Д.Г., Кузнецов Н.С., Юкина М.Ю. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению феохромоцитомы/параганглиомы. Эндокринная хирургия. 2015;9(3):15-33. [Mel’nichenko G.A., Troshina E.A., Bel’tsevich D.G., Kuznetsov N.S., Yukina M.Yu. Russian Association of Endocrinologists clinical practice guidelines for diagnosis and treatment of pheochromocytoma and paraganglioma. Endocrine Surgery. 2015;9(3):15–33. (In Russ.)]. doi: 10.14341/serg2015315-33.

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2. Figure 1. Space-occupying lesion of the left adrenal gland according to multispiral computed tomography data

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3. Figure 2. Space-occupying lesion of the left adrenal gland according to multispiral computed tomography data

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4. Figure 3. Microscopic specimen: histological picture of pheochromocytoma with moderate polymorphism, no necrosis, no invasion into the vessel wall

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