The difficult path to diagnosis: pheochromocytoma presenting as secondary arterial hypertension in an adolescent

Pheochromocytoma is a rare neuroendocrine tumor that produces catecholamines and represents a potentially curable cause of secondary arterial hypertension in children, accounting for 0.5–2 % of cases. This article discusses the clinical case of a 16-year-old female patient who sought help with complaints of high blood pressure and palpitations. Examination revealed elevated normetanephrine levels (11.57 nmol/L), a left adrenal mass (33×33×30 mm), and concentric left ventricular hypertrophy (Z-score +4.84). Following preoperative α- and β-adrenergic blockade, a laparoscopic adrenalectomy was performed. Histopathology confirmed a low-differentiated pheochromocytoma (PASS score 12). Genetic testing identified a pathogenic mutation in the VHL gene (c.250G>T). This case illustrates the diagnostic difficulties of pheochromocytoma in adolescents due to its rarity (0.5–2 % of arterial hypertension causes). The presence of hypertension with target organ damage necessitated the exclusion of secondary causes. The identification of a VHL mutation mandates lifelong surveillance. The complete resolution of symptoms and myocardial hypertrophy after surgery confirms the curable nature of the disease when diagnosed promptly.