Key Words: multiple endocrine neoplasia type 2A, pheochromocytoma, abdominal pain, pulmonary tuberculosis
Abstract
Pheochromocytoma is a catecholamine-producing neoplasm that may occur sporadically or associated with hereditary diseases, such as multiple endocrine neoplasia. The classic symptoms are headache, sweating, and palpitations and are attributed to the sympathetic nervous system activity, usually presenting as paroxysms. On the other hand, pulmonary tuberculosis is an infectious disease considered a public health problem in many countries, whose incidence depends on risk factors such as immunosuppression. It is well known that endocrine-tumor diseases such as multiple endocrine neoplasia can predispose to chronic inflammation and immunosuppression. We report the case of a 38-year-old male patient who had an episode of arterial hypertension and abdominal pain as the first symptoms of a pheochromocytoma associated with multiple endocrine neoplasia type 2A. The patient developed pulmonary tuberculosis simultaneously, but we managed to treat both entities and achieve a favorable clinical course.
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El feocromocitoma constituye una neoplasia productora de catecolaminas que se presenta de forma esporádica o asociada a enfermedades de transmisión hereditaria, como la neoplasia endocrina múltiple. Los síntomas clásicos como la cefalea, sudoración y palpitaciones son atribuidos a la actividad del sistema nervioso simpático y suelen presentarse en forma de paroxismos. La tuberculosis pulmonar es una enfermedad infecciosa que constituye un problema de salud pública en muchos países, cuya incidencia depende de algunos factores incluyendo la inmunosupresión que generan las enfermedades endocrino-tumorales como la antes descrita. Presentamos el caso de un paciente masculino de 38 años que acude a emergencia por presentar un paroxismo de hipertensión arterial y dolor abdominal, como manifestaciones iniciales de un feocromocitoma en el contexto de una neoplasia endocrina múltiple de tipo IIA. El paciente desarrolló de forma concomitante tuberculosis pulmonar; no obstante, se logró tratar ambas entidades consiguiendo una evolución clínica favorable.
Autores:
José Lavalle-Martínez[1], Mario Suárez-Montalvo[2]
Affiliation:
[1] Departamento de Emergencias del Adulto, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
[2] Departamento de Medicina Interna, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
E-mail: joselavallemartinez@gmail.com
Author address:
[1] Jirón Edgardo Rebagliati 490
Distrito de Jesús María
Ciudad de Lima
Perú
Citation: Lavalle-Martínez J, Suárez-Montalvo M. Pheochromocytoma in multiple endocrine neoplasia 2A associated with pulmonary tuberculosis presenting as abdominal pain: a case report and literature review. Medwave 2018;18(7):e7320 doi: 10.5867/medwave.2018.07.7320
Submission date: 18/7/2018
Acceptance date: 5/10/2018
Publication date: 9/11/2018
Origin: not requested
Type of review: reviewed by four external peer reviewers, double-blind
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- Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354-60. | PubMed |
- Else T. 15 YEARS OF PARAGANGLIOMA: Pheochromocytoma, paraganglioma and genetic syndromes: a historical perspective. Endocr Relat Cancer. 2015 Aug;22(4):T147-59. | CrossRef | PubMed |
- Rodriguez JM, Balsalobre M, Ponce JL, Ríos A, Torregrosa NM, Tebar J, Parrilla P. Pheochromocytoma in MEN 2A syndrome. Study of 54 patients. World J Surg. 2008 Nov;32(11):2520-6. | CrossRef | PubMed |
- Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore). 1991 Jan;70(1):46-66. | PubMed |
- Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. | PubMed |
- Raue F, Frank-Raue K, Grauer A. Multiple endocrine neoplasia type 2. Clinical features and screening. Endocrinol Metab Clin North Am. 1994 Mar;23(1):137-56. | PubMed |
- Evans JP, Bambach CP, Andrew S, Dwight T, Richardson AL, Robinson BG, et al. MEN type 2a presenting as an intra-abdominal emergency. Aust N Z J Surg. 1997 Nov;67(11):824-6. | PubMed |
- Webb TA, Sheps SG, Carney JA. Differences between sporadic pheochromocytoma and pheochromocytoma in multiple endocrime neoplasia, type 2. Am J Surg Pathol. 1980 Apr;4(2):121-6. | PubMed |
- Modigliani E, Vasen HM, Raue K, Dralle H, Frilling A, Gheri RG, et al. Pheochromocytoma in multiple endocrine neoplasia type 2: European study. The Euromen Study Group. J Intern Med. 1995 Oct;238(4):363-7. | PubMed |
- Thosani S, Ayala-Ramirez M, Palmer L, Hu MI, Rich T, Gagel RF, et al. The characterization of pheochromocytoma and its impact on overall survival in multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 2013 Nov;98(11):E1813-9. | CrossRef | PubMed |
- Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014 Jun;99(6):1915-42. | CrossRef | PubMed |
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- Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610. | CrossRef | PubMed |
- Kinlaw WB, Scott SM, Maue RA, Memoli VA, Harris RD, Daniels GH, et al. Multiple endocrine neoplasia 2A due to a unique C609S RET mutation presents with pheochromocytoma and reduced penetrance of medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2005 Dec;63(6):676-82. | PubMed |
- Alarcón V, Alarcón E, Figueroa C, Mendoza-Ticona A. [Tuberculosis in Peru: epidemiological situation, progress and challenges for its control]. Rev Peru Med Exp Salud Publica. 2017 Apr-Jun;34(2):299-310. | CrossRef | PubMed |
- Roth GM, Flock EV, Bollman JL, Kvale WF. Evaluation of the pharmacologic and chemical tests as an aid to diagnosis of pheochromocytoma. Angiology. 1959 Dec;10:426-30. | PubMed |
- Toure P, Leye A, Leye Y, Diop M, Diop M, Elfajri S, et al. Metastases Of Pheochromocytoma Or Multifocal Tuberculosis? Difficulty Of Diagnosis, A Case Report. The Internet Journal of Endocrinology. 2010;6(2):1-4 | Link |
- KA, Shankar SV, UG. Coexistent extra adrenal pheochromocytoma and extrapulmonary tuberculosis: a case report and review of literature. J Clin Diagn Res. 2012 Oct;6(8):1430-2. | CrossRef | PubMed |
Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354-60. | PubMed |Else T. 15 YEARS OF PARAGANGLIOMA: Pheochromocytoma, paraganglioma and genetic syndromes: a historical perspective. Endocr Relat Cancer. 2015 Aug;22(4):T147-59. | CrossRef | PubMed |Rodriguez JM, Balsalobre M, Ponce JL, Ríos A, Torregrosa NM, Tebar J, Parrilla P. Pheochromocytoma in MEN 2A syndrome. Study of 54 patients. World J Surg. 2008 Nov;32(11):2520-6. | CrossRef | PubMed |Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore). 1991 Jan;70(1):46-66. | PubMed |Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. | PubMed |Raue F, Frank-Raue K, Grauer A. Multiple endocrine neoplasia type 2. Clinical features and screening. Endocrinol Metab Clin North Am. 1994 Mar;23(1):137-56. | PubMed |Evans JP, Bambach CP, Andrew S, Dwight T, Richardson AL, Robinson BG, et al. MEN type 2a presenting as an intra-abdominal emergency. Aust N Z J Surg. 1997 Nov;67(11):824-6. | PubMed |Webb TA, Sheps SG, Carney JA. Differences between sporadic pheochromocytoma and pheochromocytoma in multiple endocrime neoplasia, type 2. Am J Surg Pathol. 1980 Apr;4(2):121-6. | PubMed |Modigliani E, Vasen HM, Raue K, Dralle H, Frilling A, Gheri RG, et al. Pheochromocytoma in multiple endocrine neoplasia type 2: European study. The Euromen Study Group. J Intern Med. 1995 Oct;238(4):363-7. | PubMed |Thosani S, Ayala-Ramirez M, Palmer L, Hu MI, Rich T, Gagel RF, et al. The characterization of pheochromocytoma and its impact on overall survival in multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 2013 Nov;98(11):E1813-9. | CrossRef | PubMed |Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014 Jun;99(6):1915-42. | CrossRef | PubMed |Pomares FJ, Cañas R, Rodriguez JM, Hernandez AM, Parrilla P, Tebar FJ. Differences between sporadic and multiple endocrine neoplasia type 2A phaeochromocytoma. Clin Endocrinol (Oxf). 1998 Feb;48(2):195-200. | PubMed |Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610. | CrossRef | PubMed |Kinlaw WB, Scott SM, Maue RA, Memoli VA, Harris RD, Daniels GH, et al. Multiple endocrine neoplasia 2A due to a unique C609S RET mutation presents with pheochromocytoma and reduced penetrance of medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2005 Dec;63(6):676-82. | PubMed |Alarcón V, Alarcón E, Figueroa C, Mendoza-Ticona A. [Tuberculosis in Peru: epidemiological situation, progress and challenges for its control]. Rev Peru Med Exp Salud Publica. 2017 Apr-Jun;34(2):299-310. | CrossRef | PubMed |Roth GM, Flock EV, Bollman JL, Kvale WF. Evaluation of the pharmacologic and chemical tests as an aid to diagnosis of pheochromocytoma. Angiology. 1959 Dec;10:426-30. | PubMed |Toure P, Leye A, Leye Y, Diop M, Diop M, Elfajri S, et al. Metastases Of Pheochromocytoma Or Multifocal Tuberculosis? Difficulty Of Diagnosis, A Case Report. The Internet Journal of Endocrinology. 2010;6(2):1-4 | Link |
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