PHEOCHROMOCYTOMA PRESENTING WITH PAROXYSMAL HYPERTENSION AND ADRENERGIC SYMPTOMS

Abstract

Background: Pheochromocytoma is a rare catecholamine‐secreting tumor of chromaffin cells that classically manifests with episodic headache, palpitations, and sweating, often alongside paroxysmal or sustained hypertension. Delayed recognition exposes patients to preventable cardiovascular complications.

Case: We report an anonymized adult patient who presented with paroxysmal hypertension, adrenergic symptoms, and weight loss. Biochemical evaluation revealed markedly elevated plasma free metanephrines and 24-hour urinary fractionated metanephrines. Cross-sectional imaging demonstrated a unilateral adrenal mass with avid uptake on ^123I-MIBG scintigraphy. Following meticulous preoperative alpha-adrenergic blockade and volume expansion, the patient underwent laparoscopic adrenalectomy. Histopathology confirmed pheochromocytoma with negative margins and a low PASS score. Postoperatively, blood pressure normalized without antihypertensives, and biochemical markers returned to reference ranges.

Conclusion: This case underscores the importance of high clinical suspicion, standardized biochemical testing, targeted imaging, and rigorous preoperative preparation. Early surgical management can be curative and prevents catastrophic cardiovascular events. Long-term follow-up is essential due to the risk of recurrence and the not-infrequent association with hereditary syndromes.