Unexplained Cachexia as a Presenting Symptom of Pheochromocytoma in a Geriatric Patient

Pheochromocytomas are rare neuroendocrine tumors that may secrete catecholamines, resulting in a wide array of clinical symptoms. While patients classically present with hypertension, headache, diaphoresis, and flushing, these symptoms are present in only 40% of cases. Here, we describe a 70-year-old woman whose predominant symptom was unexplained severe weight loss over a 12-month period associated with fatigue, anxiety, and palpitations at her endocrinologist and geriatrician visits. Diagnostic imaging was performed to assess for malignancy and demonstrated a 2.0 cm × 2.0 cm left adrenal mass. The diagnosis of pheochromocytoma was confirmed by elevated plasma normetanephrine levels. After a 2-week alpha blockade with doxazosin, the patient underwent robotic left adrenalectomy. Following surgery, the patient regained weight, and her hypertension also improved significantly. We hope this uncommon clinical presentation in an older adult characterized by weight loss and frailty will increase the awareness of atypical pheochromocytoma symptomatology, particularly in older individuals.