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Intracerebral hemorrhage as a first sign of pheochromocytoma: case report and review of the literature
Affiliations- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre, Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Centre, Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrine Surgery, University Clinical Centre, Medical Faculty, University of Belgrade, Belgrade, Serbia
- Clinic for Pathology, Medical Faculty, University of Belgrade, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
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Abstract
Pheochromocytomas and sympathetic paragangliomas are rare catecholamine-secreting tumours that represent very rare causes of intracerebral haemorrhage in the young, with only a few cases reported. A 32-year-old man presented to our emergency department because of sudden onset of severe headache. He had a six-month history of paroxysmal headache, palpitations, and sweating. During examination he became somnolent and developed left-sided hemiplegia. A computed tomographic (CT) scan of the brain showed a right temporoparietal haematoma. He was admitted to the Clinic for Neurosurgery and the haematoma was evacuated. The patient was comatose, on assisted respiration, with frequent hypertensive crises. An examination for possible secondary causes of hypertension was undertaken. Plasma metanephrine value was elevated (414 pg/mL, reference values < 90 pg/mL). Abdominal CT scans revealed a large mass (6 cm) in the right adrenal gland. After adequate control of the hypertension was achieved with nonselective alpha- and beta-adrenergic blockers the tumour was excised. The histopathologic findings confirmed the diagnosis of pheochromocytoma. The genetic analysis demonstrated a duplication in exon 1 of the VHL gene. We reported a rare, potentially fatal complication of pheochromocytoma — an intracerebral haemorrhage. This case and review of similar rare cases in the literature illustrate the importance of early recognition of the characteristic symptoms of catecholamine excess in young patients with hypertension.
Abstract
Pheochromocytomas and sympathetic paragangliomas are rare catecholamine-secreting tumours that represent very rare causes of intracerebral haemorrhage in the young, with only a few cases reported. A 32-year-old man presented to our emergency department because of sudden onset of severe headache. He had a six-month history of paroxysmal headache, palpitations, and sweating. During examination he became somnolent and developed left-sided hemiplegia. A computed tomographic (CT) scan of the brain showed a right temporoparietal haematoma. He was admitted to the Clinic for Neurosurgery and the haematoma was evacuated. The patient was comatose, on assisted respiration, with frequent hypertensive crises. An examination for possible secondary causes of hypertension was undertaken. Plasma metanephrine value was elevated (414 pg/mL, reference values < 90 pg/mL). Abdominal CT scans revealed a large mass (6 cm) in the right adrenal gland. After adequate control of the hypertension was achieved with nonselective alpha- and beta-adrenergic blockers the tumour was excised. The histopathologic findings confirmed the diagnosis of pheochromocytoma. The genetic analysis demonstrated a duplication in exon 1 of the VHL gene. We reported a rare, potentially fatal complication of pheochromocytoma — an intracerebral haemorrhage. This case and review of similar rare cases in the literature illustrate the importance of early recognition of the characteristic symptoms of catecholamine excess in young patients with hypertension.
Keywords
pheochromocytoma; intracerebral haemorrhage; pheochromocytoma crisis
About this articleTitle
Intracerebral hemorrhage as a first sign of pheochromocytoma: case report and review of the literature
Journal
Issue
Article type
Case report
Pages
298-303
Published online
2018-10-23
Page views
2392
Article views/downloads
1563
DOI
10.5603/EP.a2018.0075
Pubmed
Bibliographic record
Endokrynol Pol 2019;70(3):298-303.
Keywords
pheochromocytoma
intracerebral haemorrhage
pheochromocytoma crisis
Authors
Sandra Pekic
Vladimir Jovanovic
Goran Tasic
Ivan Paunovic
Svetislav Tatic
Dusko Dundjerovic
Mirjana Doknic
Dragana Miljic
Marko Stojanovic
Marina Nikolic Djurovic
Milan Petakov
Vera Popovic
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