Diencephalic epilepsy resembling pheochromocytoma: a first reported case in Thailand

A 31 year old hypertensive patient suffered from a fluctuation of blood pressure. Pheochromocytoma was suspected because of the clinical history, and extremely labile blood pressure but did not respond to therapy with alpha adrenergic blocking agent and normal excretion rates of catecholamine and vanilly mandelic acid (VMA). An enlarged left adrenal gland from computerized tomographic scan was found. So left adrenalectomy was performed and the result was consistent with cortical adrenal hyperplasia. Fluctuation of blood pressure still occurred after surgery with the symptoms of epigastric oppression and focal epileptic attack of the left arm. Epileptic potential waves were seen during hyperventilation from electroencephalogram but showed normal magnetic resonance imaging computerized tomographic scan of the brain. Diencephalic epilepsy was diagnosed and treated with anticonvulsant (carbamazepine) and eventually all of the symptoms including labile blood pressure subsided.