Case reportComputed tomography appearance of spontaneous adrenal hemorrhage in a pheochromocytoma
Introduction
Pheochromocytomas are rare catecholamine producing neuro-endocrine tumors arising from chromaffin cells of the sympathetic nervous system. The annual incidence in the US is three to eight cases per million [1]. Adrenal hemorrhage is a rare but serious complication of pheochromocytomas that has so far been reported, to our knowledge, in only about 49 cases [2]. We had a patient with classic presentation of pheochromocytoma complicated by hypertensive crisis leading to spontaneous adrenal hemorrhage. We report the computed tomographic (CT) findings of spontaneous adrenal hemorrhage in this uncommon condition, which can be life threatening if not detected early.
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Case report
A 54-year-old Caucasian male patient with past medical history of hypertension, well-controlled with metoprolol for the last 6 years, presented with chief complaint of intermittent pounding headaches for 5 days associated with palpitations, flushing, and diaphoresis. At the time of admission his blood pressure (BP) was 200/100 mmHg with heart rate of 98 beats per minute. On examination, there was no neck rigidity, jugular venous distention, or carotid bruit. Kernig's sign was negative and
Discussion
Adrenal hemorrhage is a rare but life-threatening event that may occur as a complication of underlying adrenal pathology, physiological stress, blunt trauma, sepsis, or a coagulopathic state. It may lead to acute adrenal crisis, shock, and death unless it is recognized promptly and treated appropriately [4], [5].
Conclusion
Since there is a time lapse in diagnosis of pheochromocytoma based on definitive urine tests, utilization of imaging studies and greater awareness of manifestations of spontaneous hemorrhagic pheochromocytoma amongst radiologists and clinicians will help in early recognition and treatment of this emergent and life-threatening situation.
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