Endocrinol Metab.  2014 Mar;29(1):83-90. 10.3803/EnM.2014.29.1.83.

Pheochromocytoma with Markedly Abnormal Liver Function Tests and Severe Leukocytosis

• Eun CR
• Ahn JH
• Seo JA
• Kim NH

• KMID: 2169356
• DOI: http://doi.org/10.3803/EnM.2014.29.1.83

Abstract

Pheochromocytoma is a rare neuroendocrine tumor arising from the medulla of the adrenal glands, which causes an overproduction of catecholamines. The common symptoms are headache, palpitations, and sweating; however, various other clinical manifestations might also be present. Accurate diagnosis of pheochromocytoma is important because surgical treatment is usually successful, and associated clinical problems are reversible if treated early. A 49-year-old man with a history of uncontrolled hypertension and diabetes mellitus presented with chest pain, fever, and sweating. His liver function tests and white blood cell counts were markedly increased and his echocardiography results suggested stress-induced cardiomyopathy. His abdominal computed tomography showed a 5x5-cm-sized tumor in the left adrenal gland, and laboratory tests confirmed catecholamine overproduction. After surgical resection of the left adrenal gland, his liver function tests and white blood cell counts normalized, and echocardiography showed normal cardiac function. Moreover, his previous antihypertensive regimen was deescalated, and his previously uncontrolled blood glucose levels normalized without medication.

Keyword

Liver function tests; Pheochromocytoma; Leukocytes

MeSH Terms

Adrenal Glands
Blood Glucose
Cardiomyopathies
Catecholamines
Chest Pain
Diabetes Mellitus
Diagnosis
Echocardiography
Fever
Headache
Humans
Hypertension
Leukocyte Count
Leukocytes
Leukocytosis*
Liver Function Tests*
Liver*
Middle Aged
Neuroendocrine Tumors
Pheochromocytoma*
Sweat
Sweating
Blood Glucose
Catecholamines

Figure

• 

  Fig. 1 Abdominal computed tomography scan shows the 5×5-cm-sized, heterogeneous mass in left adrenal gland (white arrow).

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  Fig. 2 Electrocardiogram shows the T-wave inversion and QT prolongation in leads II and V1-6.

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  Fig. 3 131I-Metaiodobenzylguanidine (MIBG) scan shows an increased uptake in the left upper abdomen.

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  Fig. 4 Histopathology of pheochromocytoma. (A) The tumor cells with eosinophillic cytoplasm and polygonal shape, are surrounded by mesenchyma of vasculature (H&E stain, ×200). Cromogranin (B, ×200), synaptophysin (C, ×200), and S-100 (D, ×200) are stained.

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