SHM Converge Scientific Abstract ePoster Gallery-The Silent Mimic: Unmasking Pheochromocytoma in a Patient With Uncontrolled Hyperglycemia and Intermittent Fevers

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This case report describes a 56-year-old man with type 2 diabetes and hypertension who presented with severe uncontrolled hyperglycemia, intermittent fevers, nausea, vomiting, and a 15-pound unintentional weight loss over one month. Initial evaluation suggested infection or malignancy, but infectious workup was negative. He was also found to have new heart failure with reduced ejection fraction and later developed marked blood pressure instability, with hypertensive crises alternating with orthostatic hypotension.<br /><br />Because of the atypical presentation and weight loss, CT imaging of the abdomen and pelvis was obtained and revealed a large solid-cystic left adrenal mass measuring 8 x 7 x 9.3 cm with renal vein involvement. Biochemical testing showed elevated plasma metanephrine, urine metanephrine, and plasma norepinephrine, confirming pheochromocytoma.<br /><br />The report emphasizes that pheochromocytoma can present with unusual features such as hyperglycemia and fever. Hyperglycemia may result from catecholamine-mediated suppression of insulin secretion, increased glucagon release, and insulin resistance. Fevers may be caused by catecholamine-induced inflammatory cytokines such as IL-6, though occult infection must still be excluded.<br /><br />Management required critical care monitoring due to rapid swings in blood pressure and hemodynamic instability. The patient was treated with preoperative alpha-blockade using phenoxybenzamine, fluid resuscitation, and close cardiovascular monitoring in the CCU. Metoprolol was stopped once pheochromocytoma was suspected. He ultimately underwent left adrenalectomy and nephrectomy, and pathology confirmed pheochromocytoma. After surgery, his glucose normalized, fevers resolved, and insulin was discontinued.<br /><br />The case highlights the importance of considering pheochromocytoma in patients with unexplained hyperglycemia, fevers, and weight loss, as early diagnosis and treatment are critical to reducing morbidity and mortality.

Asset Subtitle

Ayotunde I. Buremoh

Meta Tag

Author List Ayotunde I. Buremoh, Brianna Smith, Mylene E. Vista, Saira Akhtar, Yuqing Wang

Category Clinical Vignettes

Concept Pheochromocytoma

Concept Biochemical Testing

Concept Alpha Blockade

Concept Hyperglycemia

Concept Hemodynamic Instability

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center, Wakefield, New York

Presenting Author Ayotunde I. Buremoh

Track Adult

Keywords

pheochromocytoma

hyperglycemia

fever

weight loss

adrenal mass

catecholamines

hypertension

orthostatic hypotension

alpha-blockade

adrenalectomy

Pheochromocytoma

Biochemical Testing

Alpha Blockade

Hyperglycemia

Hemodynamic Instability