Diagnosis of pheochromocytoma in the setting of Parkinson disease.
BACKGROUND
A 59-year-old man with a 7-year history of Parkinson disease (PD) presented with episodes of sudden, severe headaches with neck pain, tachycardia, sweating and pallor. During these episodes, the patient showed marked elevations in blood pressure, regardless of posture. This was unusual, given that he had no prior history of hypertension. The array of symptoms raised suspicions of pheochromocytoma, but diagnosis was challenging, as the standard diagnostic biochemical tests were confounded by dopaminergic medications. Further work-up revealed left adrenal medullary hyperplasia. Several reports exist of pseudopheochromocytoma in patients on dopaminergic therapy, but this is the first documented case of pheochromocytoma syndrome due to adrenal medullary hyperplasia in a patient with PD. This case highlights the challenges of performing a diagnostic work-up in a PD patient with symptoms suggestive of pheochromocytoma, and illustrates the utility of (123)I-metaiodobenzylguanidine ((123)I-MIBG) single-photon emission CT in making a diagnosis.Investigations. Physical examination, laboratory tests, abdominal MRI scan, abdominal (123)I-MIBG scan, abdominal (18)F-fluorodeoxyglucose PET scan.


METHODS
Pheochromocytoma syndrome due to adrenal medullary hyperplasia.Management. Surgical excision of the left adrenal gland.
Mehta
Shyamal H
SH
Movement Disorders Program, Department of Neurology, Medical College of Georgia, 1429 Harper Street, Augusta, GA 30912, USA. shmehta@mcg.edu
Prakash
Rajan
R
Prisant
L Michael
LM
Isales
Carlos M
CM
Morgan
John C
JC
Williams
Hadyn
H
Sethi
Kapil D
KD
D019797:3-Iodobenzylguanidine; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D002395:Catecholamines / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications; D010673:Pheochromocytoma / Q000150:complications / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D002395:Catecholamines; D019797:3-Iodobenzylguanidine