Palpitation in a known hypertensive patient, looking beyond the obvious: A case of pheochromocytoma coexisting with hypothyroidism

Abstract

Pheochromocytoma is an uncommon tumor arising from the chromaffin cells of the adrenal medulla. It is a potential life-threatening endocrine disorder. We report a case of a 56-year-old woman who presented on account of recurrent episodes of palpitation with frontal headache that was associated with visual flashes and episodic sweating. Abdominopelvic computed tomography scan showed a well-circumscribed homogeneous mass within the left adrenal gland. The urinary metanephrine and normetanephrine were markedly raised, with an assessment of pheochromocytoma made. Pheochromocytoma should be strongly considered in any patient presenting with palpitations and other neurological symptoms after ruling out cardiac abnormalities. It is important to screen for secondary cause of hypertension in a newly diagnosed hypertensive with ultrasound, which is cheap and readily available. Likewise, ambulatory blood pressure monitoring is highly recommended in any patient with strong suspicion of pheochromocytoma but with normal blood pressure to demonstrate the lability in the pattern.