Unusual Pheochromocytoma Presentation: From Dysuria to Catecholamine Crisis

Pheochromocytomas are catecholamine-secreting tumors that can present as a surgical emergency, with a mortality rate as high as 15%. When these lesions present as a crisis, diagnosis and management can be very challenging, given the profound physiologic consequences, such as cardiovascular collapse or multiple organ failure, occurring over a rapid time frame. We describe an unusual case of a pheochromocytoma presenting with urinary frequency and subsequent shock and tumor hemorrhage following a urological procedure. Our patient was successfully managed with resuscitation and appropriate blood pressure control to stabilize hemodynamics prior to proceeding with open adrenalectomy. Furthermore, our patient presented initially with urinary symptoms, which has not been described as an initial presentation of pheochromocytoma. This case brings important learning points regarding unusually presenting pheochromocytomas and emergency management to improve patient survival.