MON-397 A Case of Recurrence of Pheochromocytoma

BACKGROUND Pheochromocytoma is a tumor arising from adrenomedullary chromaffin cells that commonly produces one or more catecholamines. Surgical removal of a pheochromocytoma does not always lead to long-term cure of pheochromocytoma, pheochromocytoma recurred in approximately 16 percent, with more frequency in patients with familial pheochromocytoma and extraadrenal tumors. CLINICAL CASE A 41 years woman with a history of hypertension diagnosed 3 years before the admission, began having puncturing holocarnaeal headache of moderate intensity 2 years before hospital admission. The pain got worse, and a chest pain and dyspnea were associated in an episodic way. These episodes were accompanied by diaphoresis, palpitations, flushing and nervousness. Patient went to a doctor being diagnosed heart failure so he receives medication, but symptomatology does not improve. The episodes became more frequent and were associated with nausea, vomiting and distal coldness. Physical examination showed: BP:160/110 HR:130 Slight diaphoresis rest without particularities Labs: 05/23/18 24 h urine: Vanilmandelic acid 25.9 (0-10 mg / 24h) Metanephrines 2.26 ((0.05-1 mg / 24h) Creatinine 0.8 (1-2 mg) Rel. Metanephrine / Creatinine 2.83 (0- 0.6) Abdominal TEM: Image of tumor appearance in right adrenal gland. 45x51mm 06/06/18 Calcitonin <2 pg / ml (0-11.5) Normal thyroid profile, normal thyroid ultrasound Pheochromocytoma was diagnosed, patient was operated with adequate pharmacologic preparation. Positive pathology to pheochromocytoma. Patient was discharged without any antihypertensive and asymptomatic 4 months after the patient returned for her control having high TA and adrenergic crises similar to those she presented before surgery. New labs were requested 15/10/18 24 h urine: Metanephrines 1.12 ((0.05-1 mg / 24h) Creatinine 1.4 (1-2mg) Rel. Metanephrine / Creatinine 0.8 (0-0.6) CONCLUSION As described in the literature, there is recurrence in pheochromocytomas especially if the size is&gt; 5 cm, which is why follow-up and individualized management is indicated even those apparently cured after a total resection. REFERENCES Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:1915. William F Young, et al. Treatment of pheochromocytoma in adults. UptoDate http://www.uptodate.com (Accessed on November 05, 2018.)