Symptomatic pheochromocytoma with normal urinary catecholamine levels
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A 53-year old female presented with headache, sweating and chest discomport. On admission, she showed a left adrenal mass on CT scan. Repeated measurements of 24-hour urinary fractionated metanephrines, total catecholamines, vanillylmandelic acid (VMA) and plasma catecholamine were within normal range. Scintigraphic 131I-MIBG revealed selective concentration of the radiotracer, corresponding to the CT mass. Plasma and urine catecholamine levels were within normal range even during paroxysmal episodes. Successful surgical excision of the tumor was performed and the pathological examination confirmed the diagnosis of a pheochromocytoma with a 2.3cm sized solid tumor. This is a rare case of a symptomatic pheochromocytoma without elevated catecholamine and its metabolite levels. Our case illustrates that in all patients with high clinical suspicion of pheochromocytoma, a routine nuclear scintigraphy should be performed even in the setting of normal biochemical testing.
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