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Kim, Kim, Lee, Kim, Jung, and Kum: A Case of Pheochromocytoma Presenting as Syncope Due to Orthostatic Hypotension
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2011; 26(2): 155-159.

Published online: 30 June 2011

DOI: https://doi.org/10.3803/EnM.2011.26.2.155

A Case of Pheochromocytoma Presenting as Syncope Due to Orthostatic Hypotension

Ji Yeun Kim, Sung Woo Kim, Seung Jun Lee, Hyun Sook Kim, Eui Dal Jung, Yun Seop Kum1

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

1Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea.

Corresponding author: Eui Dal Jung. Department of Endocrinology, Catholic University of Daegu School of Medicine, 3056-6 Daemyung 4-dong, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-4098, Fax: +82-53-651-4009, jed15@cu.ac.kr

Received 14 July 2010       Accepted 10 October 2010

Copyright © 2011 Korean Endocrine Society

Abstract

Patients with pheochromocytoma manifest with headache, perspiration, and palpitation. Although most patients have either sustained or paroxysmal hypertension, some patients present with hypotension. However, severe orthostatic hypotension is relatively rare in patients with pheochromocytoma. We report here on a 72-year-old woman with pheochromocytoma and she presented with recurrent syncope due to hypotension and blood pressure fluctuation. Syncope due to hypotension is unusual in patients with pheochromocytoma and only a few such cases have been reported. The present case serves to illustrate an unexpected presentation of this tumor.

Keywords: Hypotension, Pheochromocytoma, Syncope

Figures and Tables

Fig. 1
Preoperative 3D thoracic aorta CT showed a 3.3-cm-sized mass with irregular margin (arrow) in left upper lobe suggesting lung cancer (A), and a 5.5-cm-sized hypodense mass with internal hemorrhage (arrow) in left adrenal gland (B).
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Fig. 2
Changes of systolic blood pressure and heart rate on admission day.
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Fig. 3
Preoperative imaging study. A. On whole body PET/CT scan, the mass in left upper lobe showed mild 18F-FDG uptake (max SUV > 2.97). B. On 131I-MIBG scan, moderate radiotracer uptake was showed around the left supra-adrenal area (corresponding the mass in left adrenal area on CT scan) throughout all images on 24 hours, 48 hours, and 72 hours.
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Fig. 4
Histopathological findings of the adrenal pheochromocytoma (A-C) and lung adenocarcinoma (D). A. Cross-section of tumor showed cystic change with necrosis and hemorrhage. B. Microscopic finding of tumor showed typical zellballen pattern. Tumor cells had basophilic granular cytoplasm and round nuclei (H&E staining, × 200). C. Immunohistochemical staining of tumor cells revealed brownish S-100 positive sustentacular cells at the peripheries of the tumor cell clusters (S-100 protein staining, × 200). D. Microscopic finding of lung adenocarcinoma in the left upper lobe. The tumor showed irregular glandular cells having hyperchromatic nuclei in a fibrous stroma (H&E staining, × 200).
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Table 1
Hormonal levels
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VMA, vanillylmandelic acid.

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