Biography
Biography: Pavuluri krishna swathi
Abstract
Catecholamine secreting tumours arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia are referred to as pheochromocytomas and catecholamine secreting paragangliomas respectively. Annual incidence of pheochromocytoma is approximately 0.8/100,000 person years. Although pheochromocytomas occur at any age,they are most common in 4-5th decades of life and about 10% of catecholamine secreting tumours are malignant. Classic triad of pheochromocytoma consists of episodic headache,sweating and tachycardia. Diagnosed biochemically with 24hr urine fractionated metanephrines or catecholamines and plasma fractionates metanephrines. Radiologically with CT/MRI,FDG-PET,68-Ga DOTATATE PET and iobenguane I-123 scans. Here iam presenting a case report-38 y/o male patient with no known co-morbids came with the complaints of pain in the right hypochondrium for one week.History of palpitations on and off associated with shortness of breath on exertion. No history of fever, vomitings, headache, chestpain, cough, giddiness and loose stools. On examination, patient is conscious and oriented and PR-87/min,BP-160/70mm hg and systemic examination was normal. Baseline investigations done showed HB 13.4g/dl, TC 12,100,Platelets 5.76,MCV 79.1,PT 13.1,INR 1.13,FBS 127,PPBS 190,S.Creatinine 1.0,S.potassium 3.0,s.sodium 137,s.chloride 98,s.bicarbonate 24,SGOT 36,SGPT 39,S.albumin 4.3,S.calcium 9.8,iPTH 91.6,ALP 202,S.phosphorous 2.6,TSH 1.82,25 hydroxy Vitamin D 9.5.Urine routine showed protein(trace) and RBC(nil).USG abdomen done showed right complex supra renal cystic lesion of size 7.4x7.2 cms and on doppler increased in the vascularity in the wall of the lesion. CECT whole abdomen done showed a well-defined thick walled lesion with intense peripheral enhancement on arterial phase measuring 7x8.2x7.6 cms seen replacing the right adrenal gland with mass effect on adjacent structures i.e IVC anteromedially, upper pole of right kidney inferiorly, liver superiorly and relatively well maintained fat planes.I-131 MIBG whole body scan showed abnormal tracer uptake in both supra renal regions with large cold area in the right suprarenal region in both 48 and 72 delayed static images( bilateral pheochromocytoma).24hr urine metanephrine 1.2,24 hr urine nor metanephrine 4890(<600), Normetanephrine creatinine ratio 4890(86-236).Through clinical symptoms,biochemical and radiological evidence diagnosis of "Bilateral pheochromocytoma" was made and to confirm whether its malignant or not, patient is planned for further surgical intervention and biopsy. Patient treated symptomatically with antihypertensives and arachitol. Malignant pheochromocytomas are histologically and biochemically the same as benign ones. The only clue to the presence of malignant pheochromocytoma is local invasion in to the surrounding tissues and organs or which may occur as long as 53 years after resection, so long term follow up is required.