Introduction. Pheochromocytomas are rare tumours originating in chromaffin cells which are predominantly located in adrenal glands. Pheochromocytoma is the most “typical” cause of secondary hypertension. Sustained or paroxysmal hypertension is the most frequent sign of pheochromocytoma, possibly associated with the classic triad: episodic headaches, sudoresis and tachycardia.
Case presentation. A 52-year-old woman presented with nausea, vomiting, mild discomfort in the right abdominal flank, headache, and resistant hypertension. She had unexplained orthostatic hypotension. Her ambulatory blood pressure monitoring shows optimal blood pressure values in 65% of measurements, and a peak of hypertension at about 204/110mmHg. The computed tomography (CT) scan of head was normal, and the CT scan of the abdomen showed a heterogeneous mass between the right hepatic lobe and the right kidney, with central necrosis, dimensions 90x94x93mm, probable with the origin in the right adrenal gland. Urine catecholamines levels were high, and urine metanephrines were three times higher than the normal values. After surgery, the patient was discharged home with controlled blood pressure, without need for antihypertensive medication. At 1-year follow-up, she remained asymptomatic and with normal metanephrine values.
Conclusions. Pheochromocytoma is a cause of secondary hypertension that can be treated surgically. It is always indicated to perform surgical removal, not only for the potential treatment of hypertension but also to prevent cardiovascular complications, and to reduce the risk of malignancy.
Keywords: hypertension, pheochromocytoma, catecholamines.
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