title: Unusual presentation of pheochromocytoma with ischemic sigmoid colitis and stenosis.
abstract: A 45-year-old woman with poorly controlled hypertension and diabetes mellitus presented with left iliac fossa pain, constipation alternating with diarrhea, and weight loss. She had been diagnosed with idiopathic cardiomyopathy five years previously. Echocardiogram had shown a left ventricular ejection fraction (LVEF) of 35%; coronary angiogram was normal. Colonoscopy revealed sigmoid colitis with stenosis. Abdominal computed tomography revealed a 5 cm right adrenal tumor. Twenty-four hour urinary free catecholamines and fractionated metanephrine excretion values were elevated, confirming pheochromocytoma. Her colitis resolved after one month of adrenergic blockade. Repeat echocardiogram showed improvement of LVEF to 65%. After laparoscopic right adrenalectomy, the patient's hypertension resolved, and diabetic control improved. Timely management avoided further morbidity and potential mortality in our patient.
authors.affiliation: Department of Medicine, Sarawak General Hospital, Malaysia; and Departments of Medicine and Surgery, National University Hospital, Singapore. ftanhs@yahoo.co.uk
authors.forename: Florence
authors.initials: F
authors.lastname: Tan
authors.forename: Ah Chuan
authors.initials: AC
authors.lastname: Thai
authors.forename: Wei Keat
authors.initials: WK
authors.lastname: Cheah
authors.forename: J J
authors.initials: JJ
authors.lastname: Mukherjee
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000628:therapy; D000315:Adrenalectomy; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000150:complications; D002395:Catecholamines / Q000032:analysis; D017091:Colitis, Ischemic / Q000209:etiology* / Q000628:therapy; D012809:Colon, Sigmoid / Q000098:blood supply*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D010643:Phenoxybenzamine / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000628:therapy; D011433:Propranolol / Q000627:therapeutic use; D012810:Sigmoid Diseases / Q000209:etiology* / Q000628:therapy
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D002395:Catecholamines; D010643:Phenoxybenzamine; D011433:Propranolol