[Chronic vomiting disclosing a pheochromocytoma]

Area of Science:

• Endocrinology
• Oncology
• Gastroenterology

Background:

• Pheochromocytoma is a neuroendocrine tumor originating from chromaffin cells, typically in the adrenal medulla.
• It secretes catecholamines, leading to various clinical manifestations, including hypertension and gastrointestinal symptoms.
• Emesis (vomiting) is a recognized, though not universally common, symptom associated with pheochromocytoma.

Observation:

• A 54-year-old female patient presented with a 15-year history of emesis, initially diagnosed as biliary dyskinesia.
• Despite the prolonged symptoms, the underlying cause remained undiagnosed until bilateral pheochromocytoma was identified.
• This case underscores the potential for delayed diagnosis of pheochromocytoma when emesis is the primary or sole presenting symptom.

Findings:

• Emesis occurs in a significant percentage of pheochromocytoma cases: 26% with permanent catecholamine secretion and 43% with paroxysmal secretion.
• The patient's persistent emesis, misattributed for over a decade, exemplifies how gastrointestinal issues can mask pheochromocytoma.
• The review associated with this case aims to consolidate understanding of digestive manifestations in pheochromocytoma.

Implications:

• Delayed diagnosis of pheochromocytoma can lead to prolonged patient suffering and potential for severe, life-threatening hypertensive crises.
• Increased clinical awareness of emesis as a potential pheochromocytoma symptom is crucial for timely diagnosis.
• Recognizing the diverse gastrointestinal presentations of pheochromocytoma can improve diagnostic accuracy and patient outcomes.