The Elusive Pheo: A Case Report of Pheochromocytoma in the Emergency Department
Pheochromocytoma is a rare catecholamine-secreting endocrine tumor that can cause symptoms of episodic hypertension, diaphoresis, anxiety, and palpitations. The catecholamine release from a pheochromocytoma can cause life-threatening hypertensive episodes (hypertensive emergency). We illustrate a case of hypertensive urgency caused by a pheochromocytoma.
A 39-year-old female presented to the emergency department (ED) for the second time in one week with a chief complaint of high blood pressure and palpitations. Her past medical history was significant for hypertension (amlodipine 2.5 mg daily). Review of systems was positive for diaphoresis, shortness of breath, chest pain, and palpitations. Her blood pressure was 178/118 mm Hg, heart rate (HR) was 167 beats/minute. She was diaphoretic, distressed, hypertensive, tachycardic, and anxious. Computed tomography (CT) of the abdomen/pelvis showed a 10-cm heterogeneous enhancing left adrenal mass. She was started on a nicardipine infusion, an arterial line was placed, and she was admitted to the medical intensive care unit (MICU).
This case serves as an example of how a very serious condition can present with subtle and common symptoms. Emergency physicians should consider a pheochromocytoma in their differential diagnosis for hypertensive emergency.
Hypertensive crisis, pheochromocytoma, palpitations, shortness of breath.