Elevated urinary catecholamines and adrenal haemorrhage mimicking phaeochromocytoma

Area of Science:

• Endocrinology
• Nephrology
• Vascular Medicine

Background:

• Adrenal hemorrhage and infarction are rare conditions that can present with acute abdominal pain and hypertension.
• Pheochromocytoma is a tumor of the adrenal medulla that secretes excess catecholamines, leading to severe hypertension.
• Antiphospholipid syndrome is an autoimmune disorder associated with an increased risk of thrombosis, including in the adrenal glands.

Observation:

• A 51-year-old woman presented with flank pain and severe hypertension.
• Initial CT urogram was normal, but a repeat scan revealed left adrenal hemorrhage.
• Elevated urine catecholamines and a suboptimal cortisol response suggested pheochromocytoma.

Findings:

• The patient's hypertension resolved with phenoxybenzamine, initially supporting a pheochromocytoma diagnosis.
• Serial urinary catecholamine levels normalized, prompting a diagnostic revision.
• The final diagnosis was adrenal infarction and hemorrhage secondary to antiphospholipid syndrome.

Implications:

• Adrenal infarction should be considered in the differential diagnosis of acute abdominal pain and hypertension, especially when pheochromocytoma is suspected.
• This case highlights the importance of comprehensive diagnostic evaluation, including serial testing, for adrenal pathologies.
• Recognizing adrenal infarction as a cause of 'pseudophaeochromocytoma' can prevent misdiagnosis and guide appropriate management, potentially avoiding surgical intervention.