SHM Converge Scientific Abstract ePoster Gallery-Secondary Hypertension Due to Pheochromocytoma Incidentally Diagnosed After Cholecystitis

Pdf Summary

A 25-year-old man with ADHD and anxiety initially presented with a headache and was found to have a ruptured left frontal arteriovenous malformation (AVM) causing an intracerebral hemorrhage. Over the following 18 months, he repeatedly sought care for episodes of severe hypertension, often with systolic blood pressures above 200 mmHg and persistent tachycardia, but no evaluation for secondary hypertension was performed.<br /><br />He later presented with abdominal pain and was diagnosed with acute cholecystitis. Abdominal CT incidentally revealed a 5.5 cm right adrenal mass with central necrosis, suspicious for pheochromocytoma. Hormonal testing confirmed the diagnosis. He underwent combined cholecystectomy and adrenalectomy, and pathology showed benign pheochromocytoma. After surgery, his blood pressure normalized and antihypertensive medications were no longer needed.<br /><br />The case highlights the importance of considering secondary causes of hypertension in young patients, especially when hypertension is extreme, paroxysmal, or associated with tachycardia, diaphoresis, or other end-organ complications such as AVM rupture. Pheochromocytoma is uncommon, but this patient had several warning signs that should have prompted workup earlier.<br /><br />The report also notes an association between cerebral AVMs and pheochromocytoma in von Hippel-Lindau syndrome, as well as the relevance of SDHB loss, which can be associated with hereditary paraganglioma-pheochromocytoma syndromes and increased malignancy risk. Although genetics evaluation found no identifiable hereditary mutation in this patient, the case emphasizes avoiding anchoring bias when hypertension seems “essential” and recognizing when secondary hypertension must be investigated.

Asset Subtitle

Emily Mai

Meta Tag

Author List Emily Mai

Category Clinical Vignettes

Concept Secondary Hypertension

Concept Pheochromocytoma

Concept Episodic Hypertension

Concept Essential Hypertension

Concept Tachycardia

Distinguished Non-Finalist

Presenter Organization University of Alabama at Birmingham

Presenting Author Emily Mai

Track Adult

Keywords

pheochromocytoma

secondary hypertension

intracerebral hemorrhage

arteriovenous malformation

adrenal mass

tachycardia

hypertension

acute cholecystitis

von Hippel-Lindau syndrome

SDHB mutation

Secondary Hypertension

Pheochromocytoma

Episodic Hypertension

Essential Hypertension

Tachycardia