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KMID : 0882420120830040503
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Korean Journal of Medicine
2012 Volume.83 No. 4 p.503 ~ p.509
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A Case of Paroxysmal Pheochromocytoma with Normal Catecholamine Levels
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Yu Jung-Re
Chin Hyoun-Jung
Kim Mi-Yeon
Jeong Woo-Seong
Lee Sang-Ah
Lee Dae-Ho
Koh Gwan-Pyo
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Abstract
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A 53-year-old woman had a 1.7 cm left adrenal mass on an abdominal computed tomography (CT) scan. She presented with paroxysmal headache, palpitation, sweating, and hypertension. The patient was highly suspected of having a pheochromocytoma, but measurements of 24-hour urinary metanephrine, catecholamines, and vanillylmandelic acid were normal. Plasma and urine catecholamine levels were within the normal range even during paroxysmal episodes. A scintigraphic study with 131I-metaiodobenzylguanidine (MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. The patient underwent a left adrenalectomy and the pathological examination confirmed the diagnosis of pheochromocytoma. In this report, we describe a rare case of a symptomatic pheochromocytoma with normal catecholamine levels. Our case illustrates that routine nuclear scintigraphy, such as 131I-MIBG, should be performed even in cases with normal hormonal testing for all patients with high clinical suspicion of pheochromocytoma.
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KEYWORD
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3-iodobenzylguanidine, Catecholamines, Pheochromocytoma
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