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Abstract: FR-PO543

Unique Cause of Renal Infarction: A Case of Pheochromocytoma

Session Information

Category: Trainee Case Report

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Bindroo, Sandiya, Crozer Chester Medical Center, Upland, Pennsylvania, United States
  • Zuberi, Lubna, Crozer Chester Medical Center, Upland, Pennsylvania, United States
Introduction

Pheochromocytomas (PHEOs) are rare chromaffin cell derived neuroendocrine tumors. Common presentations include paroxysmal episodes of headache, palpitation, sweating and hypertension. Life threatening complications including renal artery stenosis, and acute myocardial infarction had been reported from the possible mechanism of catecholamine-induced vasospasm and/or extrinsic compression of renal artery in some reported cases. Here, we report an interesting case of PHEOs associated with renal infarction, unrelated to artery thrombosis/stenosis.

Case Description

A 48 year old male with no significant past medical history presents to the emergency room (ER) with sudden onset headache and blurring of vision. Vital signs revealed blood pressure of 215/120 mm of Hg. No focal neurological deficits were noted. Laboratory work was unremarkable. CT head and CT angiogram of head and neck obtained revealed no evidence of intracranial hemorrhage. He left against medical advice at that time, but returned two days later to the ER with left flank pain. This time his vital signs showed blood pressure of 100/60 mm of Hg, and he had left sided abdominal tenderness. Laboratory work revealed troponin of 23.65 ng/mL [normal, <0.04ng/ml]. Abdominal and chest CT scan showed large wedge like non-enhancing region in the lateral mid to upper pole of left kidney and solid heterogeneous 4.9 cm right adrenal gland mass. PHEOs was suspected, and he was started on doxazosin plus apixaban. Cardiac catheterization was deferred.

Specific laboratory work revealed high levels of total plasma catecholamine, plasma metanephrine, nor metanephrine, and chrmogranin A respectively. Twenty-four hour total urinary metanephrines, normetanephrines, and catecholamines were also markedly raised. The patient underwent uncomplicated laparoscopic right adrenalectomy few weeks after this admission. Surgical pathology confirmed the diagnosis of PHEOs.

Discussion

The workup and definitive diagnosis of PHEOs continue to be challenging. We present a case of PHEOs with renal infarction. Renal infarction from renal artery stenosis/thrombosis has been well documented in the literature. Our case is unique in its presentation, in that his renal infarct was independent of renal artery stenosis or thrombosis. We hypothesize, this was most likely from wide variation in blood pressure, and possible hypotensive episode, in the absence of renal artery pathology.