A 55-year-old woman presented with a 1-year history of headaches and 6-month history of palpitations. Laboratory and imaging tests found elevated urine and plasma metanephrine levels and a 3.5x2.7 cm left adrenal lesion, suggestive of a pheochromocytoma. She underwent a laparoscopic left adrenalectomy, and pathology confirmed pheochromocytoma. Her hypertension improved post-operatively.

1. Rani 55F

2. Chief complaints
• 55 year old housewife presented with
• Headache for 1 year
• Palpitations for 6 months

3. HOPI
• H/o headache for 1 year
• Dull aching type
• Paroxysmal in nature
• No aggravating and relieving factors
• Associated with profuse sweating.
• H/o palpitation for 6 months
• Spontaneous in onset
• Associated with shortness of breath
• No aggravating and relieving factors

4. • No H/o urge incontinence
• No h/o hematuria/ pyuria/calcaluria/ abdominal pain/ fever/
vomiting/ oliguria
• Patient was referred from General medicine dept

5. Past History
• Patient treated for PTB 9 years ago and completed 6 months of ATT
• K/C/O HTN x 5 years on T. Losartan 50 BD, T. Atenolol 50mg BD, T.
Hydrochlorthiazide 12.5 BD.
• No other comorbidities
• No past surgical history
Personal History
• Not a smoker or alcoholic
• Takes a mixed diet
• Normal bowel and bladder habits
Family History – No H/o similar complaints in the family

6. General Examination
• Patient is moderately built and well nourished
• Afebrile
• No pallor
• No icterus
• No pedal edema
• No generalized lymphadenopathy
• Vitals:
• BP 140/90 mm hg
• PR 74/ min

7. Per abdominal examination
• On inspection-
All quadrants move equally with respiration
Umblicus is in midline
Hernial orifices free.
• On palpation –
No warmth
No tenderness
No guarding , no rigidity
Bladder not palpable
• On percussion – No e/o free fluid
• On auscultation –Bowel sounds present.

8. Systemic Examination
• CVS-S1S2+
• RS-BAE+
• CNS-NAD

9. Investigations
• Urine R/E
• Albumin- nil,
• Sugar- nil,
• Deposits - 0-2 pus cells /HPF
• Urine c/s –no growth

10. INVESTIGATIONS
• Hb- 11.4g/dl,
• TC- 9400
• DC- 70/15/12
• PLT- 2.4 L
• Urea – 34 mg/dl
• Creatinine – 1.1mg/dl
• Na+ - 138meq/l
• K+ - 4.1meq/l
• PT- 12.9
• INR- 1.00

11. Investigations
• Blood cortisol- 20.51 mcg/dl (10-20mcg/dl)
• Urine metanephrines- 395.99mcg/24 hours (24 - 96mcg/24 hours)
• Urine normetanephrines- 1365.94mcg/24 hours (75 – 375mcg/24 hours)
• Plasma free metanephrines
• Normetanephrine – 289pg/ml (18-111pg/ml)
• Metanephrine – 114pg/ml (12-60pg/ml)

12. MRI ABDOMEN

16. MRI Abdomen
• Well defined T2 hyperintense lesion measuring 3.5x 2.7 cm noted in
left adrenal .There is no signal loss in the out of phase imaging,
possibly- malignancy/lipid poor adenoma.

17. • Patient underwent Laparoscopy assisted Left adrenalectomy on
4/10/19

18. • HPE - Consistent with
Pheochromocytoma

19. • Post op uneventful
• Hypertension was well controlled in the post operative period and
requirement of antihypertensives was reduced

20. CT chest

21. CT THORAX
• Post TB sequele with reactivation, lipid poor adenoma left adrenal
gland 3x3 cm with CT attenuation +40HU with cholelithiasis.