Abstract Introduction Pheochromocytoma is a rare neuroendocrine tumor that secretes catecholamines and can lead to severe cardiovascular complications. The most common presenting symptoms are pallor, hypertension, and tachycardia attacks or persistent hypertension. Here, we present a case of a patient with a history of flushing attacks who was admitted to the cardiology clinic with a preliminary diagnosis of NSTEMI and subsequently diagnosed with a giant adrenal mass and pheochromocytoma. Clinical Case A 40-year-old woman presented to the emergency department with chest pain, palpitations, and facial flushing. Based on ECG findings and elevated cardiac enzymes, she was admitted to the coronary intensive care unit with suspected NSTEMI. Coronary angiography revealed no significant stenosis. The patient had a known history of Behçet’s disease and was also using oral contraceptives. Pulmonary embolism was suspected, but thoracic CT showed no evidence of embolism; however, an abdominal mass of approximately 18 cm was detected. During follow-up, her systolic blood pressure rose to 170 mmHg, and she developed tachycardia of 170–180 bpm despite treatment. She was consulted to our department with a suspicion of pheochromocytoma. Upon examination, the patient was morbidly obese, and exhibited marked facial flushing. Her history revealed that she had episodes of flushing for the past-two years, lasting several minutes, with no previously documented hypertension. Abdominal CT demonstrated a lesion measuring 166×135×156 mm with cystic components adjacent to the upper pole of the left kidney. Twenty-four-hour urinary catecholamines were ordered. Doxazosin was initiated but discontinued due to hypotension. As the patient’s clinical condition deteriorated, left adrenalectomy was performed without awaiting catecholamine results, with the support of an experienced anesthesia and surgical team. Following tumor removal, hypotension was managed with fluid replacement and inotropic support. Postoperatively, tachycardia resolved, the patient became normotensive on day 2, and flushing regressed completely. Preoperative urinary normetanephrine (93,403 µg/24h) and metanephrine (2,561 µg/24h) levels were markedly elevated. Pathology confirmed pheochromocytoma with synaptophysin and chromogranin positivity and a PASS score of 9. At postoperative month 1, urinary catecholamine levels normalized, and 68Ga-DOTATATE PET/CT showed no pathological uptake. Calcitonin was negative and calcium levels were normal in MEN2 screening. Genetic testing was performed, and the results are awaited. Conclusion Pheochromocytoma should be considered in young patients presenting with hypertension and tachycardia attacks; however, it may rarely manifest with flushing episodes. In our case, if the flushing episodes over the past two years had been recognized earlier, the diagnosis might have been established before the development of such a high-risk cardiac condition. We present this case to raise awarenessFigure 1:Photograph showing the patient’s flushing episode. Figure 2: İmaging of the patient’s adrenal mass.
Aydoğan et al. (Thu,) studied this question.