Pheochromocytoma: A Case Report and Literature Review

Abstract

Background: Pheochromocytoma originated in the adrenal medulla, sympathetic ganglia and adjacent tissue. Tumor cells secrete large amounts of catecholamines continuously or intermittently, including adrenaline and (or) norepinephrine, causing persistent or paroxysmal hypertension with different levels of vasomotor dysfunction and metabolic disorders. Although pheochromocytoma occurred in the adrenal gland, but a good age, symptoms and biochemical tests consistent with the typical hormonal condition should be considered when the ectopic presence of pheochromocytoma, mediastinal pheochromocytoma is accounted about 1% of all pheochromocytoma in human body. Methods: According to the conventional diagnosis and treatment of pheochromocytoma and mediastinal tumors, combined with a typical cases of mediastinal ectopic pheochromocytoma to analyze and guild our clinical work. Results: Female patient, 44 years old. November 15, 2006 for 'discovery of hypertension three years, episodes of dizziness, palpitations 5 months' coming to the department of Endocrinology. She had attack for three times with no obvious incentive, showed sudden dizziness, palpitations, sweating under the pale, cold hands and feet but no headache, nausea and vomiting, no limb movement disorder, increased blood pressure, up to 245/150 mmHg, the local hospital considered 'pheochromocytoma'. When she had attack, blood test shown NM 105.8 pg/ml (14.0-90.0), NMN 1805.6 pg/ml (19.0- 121.0), we considered it to be pheochromocytoma. Enhanced abdominal CT scan shown: aortic lesions on both sides of abnormal enhancement, consider the paraganglioma tumor (pheochromocytoma?) (See Figure 1). CTA shown: the ectopic pheochromocytoma is next to the descending aorta, and close to the aorta, but there are still boundaries (see Figure 2). PET-CT in bilateral clavicle, upper mediastinum, abdomen and pelvis showed multiple parts of unusually high metabolic sites. Then she was transferred into the department of thoracic surgery. December 12, 2006, she had the surgery to remove the pheochromocytoma (later mediastinum) and remove the partial of thymus, we saw a 8 × 5 × 2.5 cm tumor near the right posterior mediastinum 11, 12 thoracic, one lumbar spine, descending aorta, surface and tumor parenchyma is full of blood vessels; see a small finger-like tumors in the left posterior mediastinum, about the level of 11th thoracic. Surgical pathology: 'Right after the lower mediastinum' pheochromocytoma. Then the patient recovered and was discharged after the wound healed. Conclusion: Pheochromocytoma has typical attack symptoms, but locations outside the adrenal gland should also be considered in the inspection process apart from the common incidence such as occurring in the chest, mediastinum or paravertebral, etc. We should investigate carefully in the course of treatment to find a precise way that can relieve the pain of patients by surgical resection, and can reduce recurrence.