title: Malignant nonfunctioning pheochromocytoma occurring in a mixed multiple endocrine neoplasia syndrome.
abstract: OBJECTIVE
  To present the first documented case of malignant nonfunctioning pheochromocytoma occurring in a mixed multiple endocrine neoplasia (MEN) syndrome.
  
  
  METHODS
  We describe the personal and family history of a 34-year-old man with headaches, increased serum prolactin levels, and hyperparathyroidism and review the details of his clinical course and treatment.
  
  
  RESULTS
  After diagnosis of a prolactinoma, bromocriptine therapy was implemented but eventually discontinued by the patient when severe headaches recurred. A transsphenoidal resection of a prolactinoma was performed; the patient continued to have abnormally high serum prolactin levels. Subsequent left lower flank pain prompted an exploratory laparotomy, and a left nephroad-renalectomy was performed. Pathologic examination disclosed a 1-cm tumor, consistent with malignant pheochromocytoma. Electron microscopy demonstrated neurosecretory granules. A hypercoagulable state complicated the course postoperatively. Despite chemotherapy, extensive metastatic disease ensued, and the patient died.
  
  
  CONCLUSIONS
  Although pheochromocytomas are usually associated with MEN type IIA and type IIB, this patient had a malignant pheochromocytoma, without the usual clinical and biochemical manifestations, in the setting of MEN type I.
authors.affiliation: Division of Endocrinology, Shadyside Hospital, and the University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Mozersky
authors.forename: R
authors.initials: R
authors.lastname: Girdhar
authors.forename: S
authors.initials: S
authors.lastname: Palushock
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: S
authors.initials: S
authors.lastname: Nolan
authors.forename: V K
authors.initials: VK
authors.lastname: Bahl