RESUMEN
Pheochromocytomas are rare adrenal tumors that are often diagnosed in workup for endocrine causes of refractory hypertension, as an incidental imaging finding, or in patients with classic symptoms of headache, palpitations, and/or diaphoresis. We describe a case of pheochromocytoma presenting in a 63-year-old woman with spontaneous and multifocal subarachnoid and intracerebral hemorrhage without underlying vasculopathy. The patient previously had no documented episodes of hypertension and took no regular medications. She experienced sudden-onset severe headache and presented with hypertensive crisis. Cranial imaging showed bifrontal and right temporal convexal subarachnoid and intracerebral hemorrhage of unknown etiology. Cranial arterial catheterization showed no vascular malformation underlying the site of hemorrhage. Given concern for potential malignant etiology, cross-sectional body imaging was performed that revealed a 7-cm right adrenal heterogeneous mass. Biochemical workup demonstrated markedly elevated plasma metanephrine and normetanephrine levels, diagnostic of pheochromocytoma. She underwent α- and ß-blockade, and evaluation with a multidisciplinary team including repeat intracranial imaging to ensure resolution of the intracranial bleeding before definitive surgical management. She then underwent successful laparoscopic adrenalectomy. This case demonstrates that the workup of cryptogenic intracranial hemorrhage and hypertensive crisis should include evaluation for catecholamine-secreting tumors.
RESUMEN
Hyperaldosteronism, previously thought to represent only 1% to 2% of cases of hypertension, may cause as much as 25% of hypertension in a primary care setting. The renin/aldosterone ratio is the best test for initial screening, followed by localization if possible. Aldosterone antagonists, such as spironolactone, and surgery are the mainstays of treatment. Pheochromocytomas are rare, but because they are a curable cause of hypertension and potentially fatal if not found, important to diagnose. Clinical presentation is variable; however, if symptoms are present, they usually include hypertension, hyperhydrosis, headaches, or palpitations sometimes occurring in dramatic fashion. Once a diagnosis is entertained, appropriate laboratory confirmation is essential. Positive laboratory confirmation then leads to localization of the tumor for eventual surgical removal. New biochemical tests and imaging procedures are making the difficult job of diagnosing and finding these tumors.
