Pheochromocytoma Presenting as Recurrent Syncope: A Case Report and Literature Review

Chih-Hsuan Fu ； Chin-Huan Chang

《Formosan Journal of Endocrinology and Metabolism》 8卷2期 (2017/12) Pp. 88-92

https://doi.org/10.6856/FJEM.201712_8(2).0007

摘要

Background. Neurologic symptoms caused by pheochromocytomas are often ignored. Diagnosis of pheochromocytoma is a challenge, especially when the tumor size is small (≤ 3 cm) and the patient does not present with typical symptoms. Methods. We report a 72-year-old woman with a pheochromocytoma and presented with recurrent syncope. The relationship between syncope and pheochromocytomas in literature was reviewed. Results. A 72-year-old woman was brought to our hospital with recurrent syncope. She had three episodes of syncope that developed during and after micturition. Paroxysmal hypertension (＞ 200 mmHg) alternating with hypotension (63/53 mmHg) was also recorded. CT angiography showed an incidental 2.5 cm right adrenal tumor. Elevated 24-h urine VMA (11.62 mg/24 h), epinephrine (259.8 μg/24 h), and norepinephrine (248.2 μg/24 h) were noted, but all were within normal ranges when repeated. The patient underwent an adrenal scan which showed intense FDOPA hyperintensity in the right adrenal gland. A laparoscopic right adrenalectomy was performed and a 2.5 x 2.5 x 2 cm adrenal tumor was resected. The patient had no further syncope episodes postoperatively, but still had hypertension with a systolic blood pressure around 150 mmHg. Conclusion. Pheochromocytomas should be considered in elderly patients with recurrent syncope. Orthostatic hypotension is a frequent cause of syncope in patients with pheochromocytomas. The medication history is also important because some drugs may mask the symptoms associated with pheochromocytomas.

關鍵字

hypotension ； hypertension ； pheochromocytoma ； syncope