title: [Slight hormonal alterations in a patient with a large pheochromocytoma].
abstract: We present a case report that the patient had symptoms suggesting pheochromocytoma, a large tumor (> 50 g) and a single minimally altered laboratorial test, exemplifying a diagnostic pitfall. A 31 y.o. male patient had two acute abdominal events, the last one accompanied by headache, arterial hypertension, facial flushing, perspiration and cutaneous pallor. In another admission, the patient had sustained arterial hypertension and cardiac arrhythmia. From laboratory analysis, the vanililmandelic acid was slightly modified. Scintigraphy disclosed a large adrenal mass suggesting pheochromocytoma. Histopathology confirmed this hypothesis. This report points out that patients with symptoms suggesting pheochromocytoma, even when plasma catecholamines and urinary metanephrines levels are normal, may harbor large tumors with a high catecholamines turnover or that had undergone hemorrhagic necrosis.
authors.affiliation: Departamento de Medicina Clínica, Universidade Federal do Rio Grande do Norte. josivan@usa.net
authors.forename: Josivan G de
authors.initials: JG
authors.lastname: Lima
authors.forename: Francisco
authors.initials: F
authors.lastname: Bandeira
authors.forename: Cristina H
authors.initials: CH
authors.lastname: Bandeira
authors.forename: Maurício de
authors.initials: Md
authors.lastname: Paula
authors.forename: Maria L C
authors.initials: ML
authors.lastname: Nóbrega
authors.forename: Saul O e
authors.initials: SO
authors.lastname: Costa
authors.forename: Lúcia H C
authors.initials: LH
authors.lastname: Nóbrega
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood / Q000652:urine; D002395:Catecholamines / Q000097:blood*; D002851:Chromatography, High Pressure Liquid; D006801:Humans; D008297:Male; D008676:Metanephrine / Q000652:urine; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D014642:Vanilmandelic Acid / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D002395:Catecholamines; D008676:Metanephrine; D014642:Vanilmandelic Acid