Pheochromocytoma Concealed By Chronic Methamphetamine Abuse
ABSTRACT: Objective: Both clinical suspicion and diagnosis of pheochromocytoma (PCC) can be challenging in patients where the presentation can be confused with the pharmacophysiological effects of illicit drugs known to activate the sympathetic nervous system. We report on such a patient and outlin...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-09-01
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| Series: | AACE Clinical Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520306118 |
| _version_ | 1818608154822311936 |
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| author | Georgiana Constantinescu, MD Steffen Leike, MD Matthias Gruber, MD Katharina Langton, MS Carola Kunath Mirko Peitzsch, PhD Jaap Deinum, MD, PhD Graeme Eisenhofer, PhD Jacques Lenders, MD, PhD |
| author_facet | Georgiana Constantinescu, MD Steffen Leike, MD Matthias Gruber, MD Katharina Langton, MS Carola Kunath Mirko Peitzsch, PhD Jaap Deinum, MD, PhD Graeme Eisenhofer, PhD Jacques Lenders, MD, PhD |
| author_sort | Georgiana Constantinescu, MD |
| collection | DOAJ |
| description | ABSTRACT: Objective: Both clinical suspicion and diagnosis of pheochromocytoma (PCC) can be challenging in patients where the presentation can be confused with the pharmacophysiological effects of illicit drugs known to activate the sympathetic nervous system. We report on such a patient and outline considerations that can impact diagnostic decision making. Methods: Clinical examination, measurement of plasma metanephrines, followed by magnetic resonance imaging, iodine 123-metaiodobenzylguanidine single-photon emission computed tomography, and histopathology of the resected tumor. Results: A 35-year-old male patient was referred to our center because of a right-sided adrenal mass, incidentally found during an abdominal ultrasound performed due to nausea, vomiting, and lumbar pain. Although he had no history of hypertension, he had complained for over 6 years of severe episodic headache, panic attacks, and profuse sweating. He also had a longer history of methamphetamine abuse. Plasma concentrations of metanephrine (10.7 pmol/L) and normetanephrine (3.83 pmol/L) were 25-fold and 5.6-fold above respective upper limits of reference intervals (0.42 and 0.69 pmol/L). This indicated a PCC, which was confirmed after adrenalectomy. Failure to recognize the patient’s signs and symptoms as attributable to a PCC was unsurprising given that methamphetamine abuse can result in many of the same signs and symptoms as a catecholamine-producing tumor. Conclusion: The abuse of drugs such as methamphetamine can obscure an underlying PCC due to the similarity of several symptoms associated with both conditions. Recognition of a PCC in patients using illicit drugs such as methamphetamine remains challenging. Abbreviations: NE norepinephrine PCC pheochromocytoma |
| first_indexed | 2024-12-16T14:38:08Z |
| format | Article |
| id | doaj.art-2e0abb6e9bf94ff7977c39dfd237135f |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-16T14:38:08Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-2e0abb6e9bf94ff7977c39dfd237135f2022-12-21T22:28:02ZengElsevierAACE Clinical Case Reports2376-06052020-09-0165e212e216Pheochromocytoma Concealed By Chronic Methamphetamine AbuseGeorgiana Constantinescu, MD0Steffen Leike, MD1Matthias Gruber, MD2Katharina Langton, MS3Carola Kunath4Mirko Peitzsch, PhD5Jaap Deinum, MD, PhD6Graeme Eisenhofer, PhD7Jacques Lenders, MD, PhD8Address correspondence to Dr. Georgiana Constantinescu, Department of Internal Medicine III, Technical University of Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany.; From the Department of Endocrinology, Internal Medicine III, Dresden, GermanyDepartment of Urology, Dresden, GermanyFrom the Department of Endocrinology, Internal Medicine III, Dresden, GermanyInstitute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyInstitute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyInstitute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyFrom the Department of Endocrinology, Internal Medicine III, Dresden, Germany; the Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyFrom the Department of Endocrinology, Internal Medicine III, Dresden, Germany; the Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.ABSTRACT: Objective: Both clinical suspicion and diagnosis of pheochromocytoma (PCC) can be challenging in patients where the presentation can be confused with the pharmacophysiological effects of illicit drugs known to activate the sympathetic nervous system. We report on such a patient and outline considerations that can impact diagnostic decision making. Methods: Clinical examination, measurement of plasma metanephrines, followed by magnetic resonance imaging, iodine 123-metaiodobenzylguanidine single-photon emission computed tomography, and histopathology of the resected tumor. Results: A 35-year-old male patient was referred to our center because of a right-sided adrenal mass, incidentally found during an abdominal ultrasound performed due to nausea, vomiting, and lumbar pain. Although he had no history of hypertension, he had complained for over 6 years of severe episodic headache, panic attacks, and profuse sweating. He also had a longer history of methamphetamine abuse. Plasma concentrations of metanephrine (10.7 pmol/L) and normetanephrine (3.83 pmol/L) were 25-fold and 5.6-fold above respective upper limits of reference intervals (0.42 and 0.69 pmol/L). This indicated a PCC, which was confirmed after adrenalectomy. Failure to recognize the patient’s signs and symptoms as attributable to a PCC was unsurprising given that methamphetamine abuse can result in many of the same signs and symptoms as a catecholamine-producing tumor. Conclusion: The abuse of drugs such as methamphetamine can obscure an underlying PCC due to the similarity of several symptoms associated with both conditions. Recognition of a PCC in patients using illicit drugs such as methamphetamine remains challenging. Abbreviations: NE norepinephrine PCC pheochromocytomahttp://www.sciencedirect.com/science/article/pii/S2376060520306118 |
| spellingShingle | Georgiana Constantinescu, MD Steffen Leike, MD Matthias Gruber, MD Katharina Langton, MS Carola Kunath Mirko Peitzsch, PhD Jaap Deinum, MD, PhD Graeme Eisenhofer, PhD Jacques Lenders, MD, PhD Pheochromocytoma Concealed By Chronic Methamphetamine Abuse AACE Clinical Case Reports |
| title | Pheochromocytoma Concealed By Chronic Methamphetamine Abuse |
| title_full | Pheochromocytoma Concealed By Chronic Methamphetamine Abuse |
| title_fullStr | Pheochromocytoma Concealed By Chronic Methamphetamine Abuse |
| title_full_unstemmed | Pheochromocytoma Concealed By Chronic Methamphetamine Abuse |
| title_short | Pheochromocytoma Concealed By Chronic Methamphetamine Abuse |
| title_sort | pheochromocytoma concealed by chronic methamphetamine abuse |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520306118 |
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