SHM Converge Scientific Abstract ePoster Gallery-When a Fighter Meets His Match: A Case of Hemorrhagic Pheochromocytoma

Pdf Summary

This case report describes a 39-year-old active MMA fighter with early-onset hypertension and diabetes who presented with one day of left-sided abdominal pain and repeated vomiting. Imaging with CT and MRI showed a left adrenal hemorrhage likely caused by an underlying mass. Endocrine testing revealed markedly elevated metanephrines, confirming pheochromocytoma. Although genetic testing was negative, the patient’s presentation raised concern for a hormonally active adrenal tumor with spontaneous bleeding, a rare but dangerous complication.<br /><br />Because of the diagnosis, the patient was started on preoperative alpha-blockade with phenoxybenzamine to control blood pressure before surgery. He then underwent laparoscopic left adrenalectomy. After surgery, his metanephrine levels and blood pressure improved substantially, and his A1c also decreased.<br /><br />The report highlights several key clinical points: spontaneous hemorrhage in pheochromocytoma is uncommon but can cause retroperitoneal or intraperitoneal bleeding and may be fatal. Patients with hemorrhagic adrenal masses should undergo hormonal evaluation to rule out pheochromocytoma. Imaging with both CT and MRI can help identify the lesion. If there is massive bleeding or hemodynamic instability, emergency surgery may be required. For stable patients, alpha-adrenergic blockade remains the first-line preoperative treatment. <br /><br />The authors emphasize maintaining a broad differential diagnosis in young patients with hypertension and diabetes, since delayed recognition can lead to severe complications and high mortality. They also stress the importance of lifelong follow-up after surgery, because even sporadic pheochromocytomas can recur.

Asset Subtitle

Mylene E. Vista

Meta Tag

Author List Ayotunde I. Buremoh, Brianna Smith, Huixian Zhou, Kristin Swedish, Mylene E. Vista, Wenyuan Li, Yuqing Wang

Category Clinical Vignettes

Concept Pheochromocytoma

Concept Alpha-Adrenergic Blockade

Concept Hypertension

Concept Adrenal Hemorrhage

Concept Adrenal Mass

Distinguished Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Mylene E. Vista

Track Adult

Keywords

pheochromocytoma

adrenal hemorrhage

alpha-blockade

phenoxybenzamine

laparoscopic adrenalectomy

metanephrines

hypertension

diabetes

CT MRI imaging

spontaneous bleeding

Pheochromocytoma

Alpha-Adrenergic Blockade

Hypertension

Adrenal Hemorrhage

Adrenal Mass