The diagnosis of pheocromocytoma is sometimes difficult since its clinical presentation is quite variable. Despite hypertension being the most consistent sign, even it does not occur in some pheocromocytomas. Especially when there is not a
typical
hypertensive crisis, making diagnosis of pheocromocytoma inevitably started from an inincidentally discovered adrenal mass (incidentaloma) or started from having a high index of suspicion when a patient present with subtle symptoms such as acute
or
chronic abdominal pain. diabetes, orthostatic hypotension, and pallor or flushing.
Herein we present the case of a of a 41 year old woman who developed acute, severe abdominal pain induced by hemorrhagic necrosis of a previously unsuspected pheocromocytoma. During the evaluation of her acute right abdominal pain, right adrenal
mass
meass measuring 7cm in diameter and having 3cm central necrosis was incidentally discovered on abdominal C-T. She did not have hypertension, a paroxysmal crisis or any other symptoms which would have made us suspect pheochromocytoma shorthy after
presenting she started to show hypertensive crisis after development of central necrosis in the adrenals. Necrosis in the mass can begin to induce paroxysmal crisis in a pheochromocytoma.
We were able to reach the diagnosis of pheocromocytoma from evaluation of her acute sever abdominal pan induced by hemorrhagic caentral necrosis and the incidentaloma found on the right adrenal gland. Also her past history of orthostatic
hypotension,
diabetes and headache help us suspect that the adrenal mas was a pheocromocytoma.
|