Citation Information :
Bahemia IA, Thomas TS, Mahyoodeen NG, Puttergill B. Double Trouble: A Case of a Composite Pheochromocytoma. World J Endoc Surg 2022; 14 (1):27-30.
Introduction: Pheochromocytomas are rare neuroendocrine tumors that arise from the chromaffin cells of sympathetic or parasympathetic tissue. Composite pheochromocytomas have additional histological components and account for only 3% of pheochromocytomas. We present a case of composite pheochromocytoma with chronic diarrhea, profound hypokalemia, and global weakness on presentation.
Case description: The patient reported an 18-month history of severe vomiting and watery diarrhea, with no associated headaches or sweating. She had an initial serum potassium of 1.1mmol/L (3.5–5.3), requiring a continuous intravenous potassium infusion, intubation, and ventilation for profound weakness. She remained normotensive throughout. A computed tomography (CT) scan revealed a left adrenal mass. She had markedly elevated urine metanephrine and normetanephrine levels [19,823 nmol/24 hr (152–913) and 17,933 nmol/24 hr (262–2129), respectively]. The patient underwent a left adrenalectomy and had complete resolution of her symptoms postoperatively. Histology revealed a composite tumor comprising both pheochromocytoma and ganglioneuroma.
Conclusion: This case highlights a rare presentation of pheochromocytoma, being an unusual cause of hypokalemia as well as interesting histopathology.
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