SHM Converge Scientific Abstract ePoster Gallery-The Hidden Danger: Extra-Adrenal Pheochromocytoma in a Case of Resistant Hypertension and Intracranial Hemorrhage

Pdf Summary

This case describes a 49-year-old man with obstructive sleep apnea and long-standing resistant hypertension who presented with severe headache, dizziness, nausea, and vomiting. On arrival, he had markedly elevated blood pressure despite taking multiple antihypertensive medications. A CT scan revealed a left cerebellar hemorrhage, and he was treated urgently with nicardipine and seizure prophylaxis. Although neurologically stable, his systolic blood pressure remained persistently high despite escalating therapy with several agents, and repeat imaging showed progression of the hemorrhage.<br /><br />Because of the refractory hypertension, clinicians investigated secondary causes. Renal artery stenosis and hyperaldosteronism were ruled out, but elevated urinary metanephrines suggested a catecholamine-secreting tumor. Imaging did not identify an adrenal mass, but an MIBG scan detected abnormal uptake near the cecum, confirming an extra-adrenal paraganglioma. The patient was started on metyrosine to reduce catecholamine synthesis, which helped stabilize blood pressure into the 130–140 mmHg range. He was planned for outpatient surgical resection.<br /><br />The report emphasizes that pheochromocytomas and paragangliomas can present with dangerous, difficult-to-control hypertension and, rarely, intracranial hemorrhage. Management is challenging because blood pressure targets overlap with those used for hemorrhagic stroke, but medication choice differs. In catecholamine excess, alpha-blockade should come first, with beta-blockers added only after alpha-blockade to avoid unopposed alpha stimulation. Plasma and urinary metanephrines remain the diagnostic gold standard, and functional imaging such as MIBG is useful when standard imaging is inconclusive.<br /><br />Overall, this case highlights the importance of considering pheochromocytoma/paraganglioma in patients with resistant hypertension, especially when hypertensive crisis is accompanied by intracranial hemorrhage.

Asset Subtitle

Camila Villacreses

Meta Tag

Author List Andrew Lamb, Camila Villacreses, Jimmy Chan-Pong, Michael Sabina, Zein Barakat

Category Clinical Vignettes

Concept Pheochromocytoma

Concept Paraganglioma

Concept Extra-adrenal Origin

Concept Catecholamine

Concept Metanephrines

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health Medical Center

Presenting Author Camila Villacreses

Track Adult

Keywords

resistant hypertension

obstructive sleep apnea

cerebellar hemorrhage

hypertensive crisis

pheochromocytoma

paraganglioma

catecholamine-secreting tumor

metanephrines

MIBG scan

metyrosine

Pheochromocytoma

Paraganglioma

Extra-adrenal Origin

Catecholamine

Metanephrines