Pheochromocytoma Masquerading as Weight Loss - a Diagnostic and Management Challenge

Abstract Introduction: Classic pheochromocytoma symptoms include headache, diaphoresis, palpitations and symptomatic pheochromocytomas are on average around 5cm. They respond to preoperative alpha blockade followed by surgery. We present a case of giant 15.9cm with delayed presentation diagnosis complicated atypical nausea, weight loss; preparation included modified high-dose phenoxybenzamine but she underwent successful Case Description: A 62-year-old female history hypertension diabetes presented nausea 80 lbs loss over 18 months. CT scan revealed large centrally necrotic mass overlying the left kidney, measuring 15.9 x 12.7 14.7cm. Abdominal MRI showed claw sign; was admitted urology service for tube feeding prior resection suspected renal cell carcinoma. Given location hypertension, plasma metanephrines, in workup, were notable for: total metanephrines >40000 pg/ml (reference range <=205), normetanephrines >20000 <=148), 57 <=57). Endocrine consulted started phenoxybenzamine; volume replacement fluids salt tablets. Due vomiting unable reliably tolerate oral medication; BP management challenging. Oral pill dosing minimized. Metoprolol converted metoprolol SA suspension that could be delivered through good absorption made. On day surgery, 117/76 mmHg, supine HR 92 bpm, daily dose 240mg, 200mg amlodipine 10mg. She radical nephrectomy adrenalectomy. Plasma six weeks later normal: 84 pg/ml, <25 pg/ml. Pathology benign pheochromocytoma. Conclusion: Giant significant challenges clinicians who must aware potential nonspecific which can delay diagnosis. Paroxysmal happens only about 50% patients; primary is often diagnosed, as had been our patient. Additionally, initial imaging related presenting may not lead specific diagnosis, patient; metanephrine screening correct Regarding management, dosage delivery should tailored individual patient needs, adjustment needed alternative preparations considered optimally control reduce risk death other perioperative complications. Our highlights diagnostic challenge patients pheochromocytomas.