6552 A soft case of Pheochromocytoma

Abstract Disclosure: W. Lai: None. V. Delsignore: None. S. Steven: None. Introduction: Pheochromocytoma is a rare condition estimated to occur in less than 0.2% of patients with hypertension 1. Symptomatology is critical in prompting suspicion for testing for pheochromocytoma with patients going undiagnosed up to 50% of the time based on one post mortem study 2. The following is an atypical case of pheochromocytoma in which the initial presenting symptom was erectile dysfunction. Case: The patient is a 37 year old male who had been complaining of difficulty obtaining and maintaining erections as well as fatigue over the past year prior to presentation. He subsequently began experiencing frequent episodes of nausea, vomiting, headaches, sweating, palpitations, and pallor which resulted in several visits to local emergency departments. Despite having no known prior history of tachycardia or hypertension, he was found to be both tachycardic and hypertensive. Abdominal computed tomography (CT) demonstrated a septated right adrenal mass measuring 8.0x7.7x7.4cm. The lesion measured 44 Hounsfield units (HU) on pre-contrast imaging, 57 HU one minute following contrast administration, and 58 HU ten minutes following contrast administration on dedicated adrenal CT. Laboratory studies revealed serum metanephrines of 3,919pg/mL and serum normetanephrines of 3,184pg/mL as well as 24 hour urinary metanephrines of 22,154ug and 24 hour urinary normetanephrines of 8,702ug. His symptomatic episodes resolved after starting a low dose of doxazosin. He underwent laparoscopic resection of the adrenal mass with surgical pathology revealing pheochromocytoma with a Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) of 8. Serum metanephrine and normetanephrine levels and 24 hour urinary metanephrine and normetanephrine levels became undetectable following surgical intervention. His erectile dysfunction and other symptoms completely resolved. Conclusion: Pheochromocytomas can pose a diagnostic challenge and therefore require a high level of clinical suspicion based on symptoms. The classic triad for pheochromocytoma which includes headaches, sweating, and tachycardia is relatively uncommon with paroxysmal findings occurring more often. There has been only one other documented case in which the initial presenting symptom of pheochromocytoma was erectile dysfunction, but this case illustrates that erectile dysfunction should certainly be considered as one of the possible symptoms that raises suspicion for pheochromocytomas 3. Presentation: 6/3/2024