Pheochromocytoma Concealed By Chronic Methamphetamine Abuse

Abstract

Objective: Both clinical suspicion and diagnosis of pheochromocytoma (PCC) can be challenging in patients where the presentation can be confused with the pharmaco-physiological effects of illicit drugs known to activate the sympathetic nervous system. We report on such a patient and outline considerations that can impact diagnostic decision making. Methods: Clinical examination, measurement of plasma metanephrines, followed by magnetic resonance imaging , iodine 123-metaiodobenzylguanidine single-photon emission computed tomography, and histopathology of the resected tumor. Results: A 35-year-old male patient was referred to our center because of a right-sided adrenal mass, incidentally found during an abdominal ultrasound performed due to nausea, vomiting, and lumbar pain. Although he had no history of hypertension, he had complained for over 6 years of severe episodic headache, panic attacks, and profuse sweating. He also had a longer history of metham-phetamine abuse. Plasma concentrations of metanephrine (10.7 pmol/L) and normetanephrine (3.83 pmol/L) were 25-fold and 5.6-fold above respective upper limits of reference intervals (0.42 and 0.69 pmol/L).