R Lamberts1, H Kreuzer. 1. Abteilung Gastroenterologie der Medizinischen Klinik I, Universität Tübingen.
Abstract
HISTORY AND CLINICAL FINDINGS: A 66-year-old woman, for 18 months known to have a phaeochromocytoma of the left adrenal, developed sciatica-like pain, headaches, vomiting, diarrhoea and dyspnoea. She had previously refused operative treatment. Physical examination was largely negative. But within a few hours of admission she developed a fever (40.5 degrees C) as well as cardiopulmonary and renal failure. She had to be intubated. INVESTIGATIONS: There was leukocytosis (20,800/microliters) and an increase in creatine kinase activity (136 U/l), in the proportion of isoenzyme CKMB (19 U/l) and the creatine level (1.5 mg/dl). Coronary angiography excluded coronary heart disease. Compared with previous x-rays there was a definite increase in the space-occupying process in the area of the left adrenal. TREATMENT AND COURSE: The life-threatening state required emergency removal of the adrenal tumour. The operation was without complications, but muscle weakness set in, especially proximally, and was slow to regress. No cause was found. CONCLUSIONS: Primary manifestation of a phaeochromocytoma in the form of multiple organ failure is rare and its diagnosis is based on symptoms and radiological demonstration of the tumour, because biochemical data are obscured by the need to give catecholamines therapeutically. If the general condition deteriorates during conservative treatment immediate removal of the tumour is mandatory in view of the otherwise high death rate.
HISTORY AND CLINICAL FINDINGS: A 66-year-old woman, for 18 months known to have a phaeochromocytoma of the left adrenal, developed sciatica-like pain, headaches, vomiting, diarrhoea and dyspnoea. She had previously refused operative treatment. Physical examination was largely negative. But within a few hours of admission she developed a fever (40.5 degrees C) as well as cardiopulmonary and renal failure. She had to be intubated. INVESTIGATIONS: There was leukocytosis (20,800/microliters) and an increase in creatine kinase activity (136 U/l), in the proportion of isoenzyme CKMB (19 U/l) and the creatine level (1.5 mg/dl). Coronary angiography excluded coronary heart disease. Compared with previous x-rays there was a definite increase in the space-occupying process in the area of the left adrenal. TREATMENT AND COURSE: The life-threatening state required emergency removal of the adrenal tumour. The operation was without complications, but muscle weakness set in, especially proximally, and was slow to regress. No cause was found. CONCLUSIONS: Primary manifestation of a phaeochromocytoma in the form of multiple organ failure is rare and its diagnosis is based on symptoms and radiological demonstration of the tumour, because biochemical data are obscured by the need to give catecholamines therapeutically. If the general condition deteriorates during conservative treatment immediate removal of the tumour is mandatory in view of the otherwise high death rate.
Authors: Graeme Eisenhofer; Graham Rivers; Alejandro L Rosas; Zena Quezado; William M Manger; Karel Pacak Journal: Drug Saf Date: 2007 Impact factor: 5.606