Pheochromocytoma presenting with achalasia: exploring a possible link

Although the adrenergic triad is traditionally regarded as the classic manifestation of pheochromocytoma, an increasing proportion of cases are now incidentally identified during evaluation for co-occurring conditions. To our knowledge, no published reports have described the copresentation of achalasia and a pheochromocytoma. A 62-year-old woman presented with several months of progressive cough, intermittent nonbloody, nonbilious emesis, dysphagia, and unintentional weight loss. Computed tomography of the chest, abdomen, and pelvis demonstrated multifocal pneumonia, achalasia, and an incidental 5.7-cm left adrenal mass. High-resolution esophageal manometry confirmed type II achalasia. The diagnosis of pheochromocytoma was established based on characteristic imaging features and markedly elevated plasma normetanephrine levels-approximately 30-fold above the upper limit of normal. Following adrenalectomy, biochemical values normalized, and her achalasia-related symptoms significantly improved. Although it could be merely a co-occurrence of achalasia and pheochromocytoma, the improvement in achalasia symptoms after adrenalectomy suggests that elevated catecholamines may contribute to or exacerbate esophageal motor dysfunction in some patients with pheochromocytoma.