SHM Converge Scientific Abstract ePoster Gallery-A 21-Year-Old With Malignant Hypertension and Intracranial Hemorrheage: A Hidden Pheochromocytoma

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A 21-year-old woman with no prior medical history presented repeatedly with severe, difficult-to-control hypertension and symptoms including thunderclap headache, nausea, vomiting, diaphoresis, photophobia, chest pain, dyspnea, paresthesias, and syncope. During her first visit, her blood pressure was 204/137 mmHg. Initial workup, including physical exam, blood tests, and toxicology screening, was unrevealing. On a later visit, she remained hypertensive despite metoprolol and was started on amlodipine. At a third visit, she had syncope, severe headache, hyponatremia, and hypokalemia. Neuroimaging showed an intracranial hemorrhage with associated subdural and trace subarachnoid hemorrhage.<br /><br />Further evaluation revealed a 4.7 x 2.8 cm right adrenal mass on CT with washout characteristics. Given the recurrent hypertensive crises and adrenal lesion, pheochromocytoma was suspected. Biochemical testing showed markedly elevated normetanephrine levels, while metanephrine and VMA were normal. The patient was managed with antihypertensive therapy including amlodipine, spironolactone, carvedilol, and metoprolol, and was referred to endocrinology and endocrine surgery. After adrenalectomy, she continued on alpha- and beta-blockade and her blood pressure improved to 133/90 mmHg.<br /><br />This case highlights pheochromocytoma as a rare but critical cause of secondary hypertension in young adults. It emphasizes that recurrent hypertensive emergencies, especially when accompanied by neurologic complications such as intracranial hemorrhage, should prompt evaluation for catecholamine-secreting tumors. Early diagnosis using metanephrine testing and timely surgical treatment can reduce morbidity and prevent future life-threatening crises. Lifelong follow-up is essential.

Asset Subtitle

Maria Mustafa

Meta Tag

Author List Jamie Chin-Theodoru, Maria Mustafa

Category Clinical Vignettes

Concept Pheochromocytoma

Concept Secondary Hypertension

Concept Catecholamine Excess

Concept Metanephrine

Concept Normetanephrine

Distinguished Non-Finalist

Presenter Organization Northwest Health Porter/ Healthlinc

Presenting Author Maria Mustafa

Track Adult

Keywords

pheochromocytoma

secondary hypertension

hypertensive crisis

adrenal mass

normetanephrine

intracranial hemorrhage

young adult

adrenalectomy

catecholamine-secreting tumor

recurrent syncope

Pheochromocytoma

Secondary Hypertension

Catecholamine Excess

Metanephrine

Normetanephrine