title: Pheochromocytoma multisystem crisis treated with emergency surgery: a case report and literature review.
abstract: BACKGROUND
  Pheochromocytoma is a neuroendocrine tumor that predominantly presents with hypertension, palpitations, and tachycardia due to excessive catecholamine excretion. Although pheochromocytoma multisystem crisis (PMC) is relatively rare, urologists and clinicians should focus on early diagnosis as delay in initiating the appropriate treatment can lead to mortality
  
  
  METHODS
  A 70-year-old man developed ileus after a few days of medication for hypertension. Computed tomography incidentally revealed a left adrenal mass. This finding together with his clinical course was compatible with pheochromocytoma. An α-blocker was administered immediately, and his blood pressure was well controlled. However, his general condition and laboratory data deteriorated rapidly, and the patient was diagnosed with PMC with lethal status. Thus, emergency adrenalectomy was performed without confirmation of catecholamine levels. From the resected specimen, his tumor was judged as pheochromocytoma. On immunohistochemical analysis, the proliferation index evaluated by Ki-67 staining was 9.7 %. This case report was approved by the Human Ethics Review Committee of the Nagasaki University Hospital.
  
  
  CONCLUSIONS
  The present case of PMC was successfully treated with emergency surgery. The benign pheochromocytoma also presented with high cell proliferation potential, which may be a cause of the extreme aggressiveness of PMC.
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. k-kakoki@nagasaki-u.ac.jp.
authors.forename: Katsura
authors.initials: K
authors.lastname: Kakoki
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. int.doc.miya@m3.dion.ne.jp.
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. yshida.urodr@gmail.com.
authors.forename: Youhei
authors.initials: Y
authors.lastname: Shida
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. erbb2jp@yahoo.co.jp.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Hakariya
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. takehara@nagasaki-u.ac.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Takehara
authors.affiliation: Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8501, Japan. seiya-izumida@nagasaki-u.ac.jp.
authors.forename: Seiya
authors.initials: S
authors.lastname: Izumida
authors.affiliation: Division of Intensive Care, Nagasaki University Hospital, Nagasaki, 852-8501, Japan. m-sekino@nagasaki-u.ac.jp.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Sekino
authors.affiliation: Department of Pathology, Nagasaki University Hospital, Nagasaki, 852-8501, Japan. daimonji@nagasaki-u.ac.jp.
authors.forename: Naoe
authors.initials: N
authors.lastname: Kinoshita
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. tigawa@med.kurume-u.ac.jp.|Department of Urology, Kurume University Hospital, Fukuoka, 830-0011, Japan. tigawa@med.kurume-u.ac.jp.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Igawa
authors.affiliation: Department of Pathology, Nagasaki University Hospital, Nagasaki, 852-8501, Japan. fukuokaj@nagasaki-u.ac.jp.
authors.forename: Junya
authors.initials: J
authors.lastname: Fukuoka
authors.affiliation: Department of Urology, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. hsakai@nagasaki-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sakai
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D006801:Humans; D008297:Male; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*