Undiagnosed pheochromocytoma in a patient with acute appendicitis: a challenging surgical emergency condition
Ali Coskun1, Mehmet Yildirim1, Serhat Akay1, Nazif Erkan1,2
1Izmir Bozyaka Training and Research Hospital Department of Surgery
2Izmir Bozyaka Training and Research Hospital Department of Emergency Medicine
Keywords: Pheochoromocytoma, surgery, emergency
Pheochoromocytoma is a rare catecholamine secreting neuroendocrine tumor originating mostly from adrenal glands. A clinical challenge arises when a patient with a previously undiagnosed and untreated pheochromocytoma presents with a surgical emergency. A 24-years-old male presented to our emergency department with abdominal pain. Physical examination, laboratory tests and radiological findings were consistent with acute appendicitis. Prior surgery, his blood pressure raised to 240/130
mmHg, while heart rate was 125/min. Vital signs were stabilized by intravenous nitrates and beta blockers. Appendectomy was done without further complications. After surgery, high level of urine vanillyl mandelic acid and right adrenal mass in abdominal MRI that support the diagnosis of pheochoromocytoma were found. Elective right adrenalectomy was made two months later and pathology revealed a pheochoromocytoma. The postoperative period was uneventful and he has been followed for 18 months without any antihypertensive treatment.