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Published on: September 15, 2017
Triad of cluster-like headaches, hypertension and hypercoagulability a pointer to pheochromocytoma
Archana Rampuria1, Thomas Mathew2, Aditya Honnali Ravindranath3
1Dept of Medicine, St John's National Academy of Health Sciences, Bangalore, Karnataka, India.
Insights
A middle-aged woman
Area of Science:
- Neurology
- Endocrinology
- Vascular Surgery
Background:
- Hypertension and episodic headaches are common neurological complaints.
- Arterial thrombosis can lead to severe limb ischemia.
- Pheochromocytoma is a rare adrenal tumor causing significant morbidity.
Observation:
- A patient with a history of hypertension and cluster headaches developed arterial claudication.
- Imaging revealed extensive bilateral lower limb arterial thrombosis and an incidental adrenal lesion.
- Biochemical tests confirmed elevated catecholamines, indicative of pheochromocytoma.
Findings:
- The adrenal lesion was diagnosed as a pheochromocytoma via histopathology after surgical resection.
- Successful management of pheochromocytoma led to remarkable symptom improvement.
- This case underscores the link between pheochromocytoma and hypercoagulability.
Implications:
- Pheochromocytoma should be considered in patients with refractory headaches, hypertension, and hypercoagulability.
- Early diagnosis and treatment of pheochromocytoma can prevent severe vascular complications.
- This case emphasizes the multidisciplinary approach required for complex endocrine-vascular presentations.
Abstract:
We report the case of a middle-aged hypertensive woman presenting to the neurology department with short-lasting episodic headaches for 4 years. She was initially diagnosed and treated with cluster headaches for one year. Following this, she presented with right lower limb arterial claudication. Arterial Doppler of lower limbs showed thrombosis of the bilateral common femoral arteries. Further computed tomography (CT) angiogram of the lower limbs confirmed extensive arterial thrombosis in bilateral lower limbs. The CT angiogram incidentally detected a left adrenal lesion. She had elevated urinary vanillylmandelic Acid and 24-hour metanephrines suggesting the presence of a pheochromocytoma. She was initially medically managed and later underwent left open adrenalectomy. Histopathology examination of the sections proved pheochromocytoma. Postsurgery, the patient's symptoms improved remarkably. This case highlights the importance of diagnosing pheochromocytoma when you encounter a patient with refractory short-lasting headaches, hypertension and hypercoagulability.
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