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Severe bilateral hypertensive retinopathy and optic neuropathy in a patient with pheochromocytoma
D Petkou1, I K Petropoulos, A Kordelou
1Department of Ophthalmology, General Hospital of Patras 'O Agios Andreas', Patras, Greece.
Background:
We present a case of severe bilateral hypertensive retinopathy and optic neuropathy due to pheochromocytoma.
History And Signs:
A 31-year-old woman presented with severe bilateral visual acuity loss associated with headaches and photophobia. Ophthalmoscopy showed bilateral optic disc edema, soft exudates, macular star, flame-shaped hemorrhages and arterial narrowing. The situation was more severe in the right eye. Fluorescein angiography confirmed the diagnosis of hypertensive retinopathy. Arterial blood pressure was 220/145 mmHg. A thorough systemic control revealed a right adrenal gland mass. Catecholamine secretion was normal. After ablation, the tumor proved to be a pheochromocytoma, and immunohistochemistry showed dopamine secretion.
Therapy And Outcome:
Postoperative evolution was uncomplicated. Antihypertensive treatment lasted only a few months. Visual acuity was restored and the retinal alterations disappeared 8 months after surgery.
Conclusions:
Severe hypertensive retinopathy with optic neuropathy may be a consequence of malignant hypertension due to a pheochromocytoma. It is reversible after ablation of the tumor. Early diagnosis is of vital importance and relies on hormonal investigation and immunohistochemistry.
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