Vol 70, No 3 (2019)
Case report
Published online: 2018-10-23

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Intracerebral hemorrhage as a first sign of pheochromocytoma: case report and review of the literature

Sandra Pekic1, Vladimir Jovanovic2, Goran Tasic2, Ivan Paunovic3, Svetislav Tatic4, Dusko Dundjerovic4, Mirjana Doknic1, Dragana Miljic1, Marko Stojanovic1, Marina Nikolic Djurovic1, Milan Petakov1, Vera Popovic5
Pubmed: 30351443
Endokrynol Pol 2019;70(3):298-303.

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.

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