Clinical Review Lesson of the week

Pitfalls in the diagnosis of phaeochromocytoma

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7440.629 (Published 11 March 2004) Cite this as: BMJ 2004;328:629
  1. L Zendron, fellow1,
  2. J Fehrenbach, resident1,
  3. C Taverna, fellow, oncology2,
  4. M Krause ([email protected]), attending physician1
  1. 1 Department of Internal Medicine, Kantonsspital Münsterlingen, CH-8596 Münsterlingen, Switzerland
  2. 2 Division of Oncology, Department of Internal Medicine, University Hospital, Rümistrasse 100, CH-8091 Zürich, Switzerland
  1. Correspondence to: M Krause

    Introduction

    Phaeochromocytoma, a rare endocrine disorder causing arterial hypertension, is found in less than 0.1% of patients with hypertension.1 The diagnosis is excluded by the repeated finding of normal catecholamine (for example, dopamine) concentrations in urine or blood. If catecholamine concentrations are increased in combination with an adrenal mass, phaeochromocytoma is usually confirmed by an increased uptake of a radiolabelled catecholamine precursor in the region of the adrenal tumour. We present a case in which the clinical presentation and the results of laboratory, radiological, and nuclear investigations led to an incorrect diagnosis of phaeochromocytoma.

    Case report

    A 73 year old woman presented with severe headache, tinnitus, and a blood pressure of 240/140 mm Hg. She had been treated for arterial hypertension and diabetes mellitus for over 10 years. During a search for secondary hypertension, abdominal ultrasonography showed an enlargement of the right adrenal gland of 3.5 cm. The dopamine level in a 24 hour urine was 25 252 nmol …

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