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http://dx.doi.org/10.3904/kjm.2012.83.4.503

A Case of Paroxysmal Pheochromocytoma with Normal Catecholamine Levels  

Yu, Jung-Re (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine)
Chin, Hyoun-Jung (Department of Internal Medicine, Hankook General Hospital)
Kim, Mi-Yeon (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine)
Jeong, Woo-Seong (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine)
Lee, Sang-Ah (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine)
Lee, Dae-Ho (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine)
Koh, Gwan-Pyo (Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine)
Publication Information
The Korean Journal of Medicine / v.83, no.4, 2012 , pp. 503-509 More about this Journal
Abstract
A 53-year-old woman had a 1.7 cm left adrenal mass on an abdominal computed tomography (CT) scan. She presented with paroxysmal headache, palpitation, sweating, and hypertension. The patient was highly suspected of having a pheochromocytoma, but measurements of 24-hour urinary metanephrine, catecholamines, and vanillylmandelic acid were normal. Plasma and urine catecholamine levels were within the normal range even during paroxysmal episodes. A scintigraphic study with $^{131}I$-metaiodo-benzylguanidine (MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. The patient underwent a left adrenalectomy and the pathological examination confirmed the diagnosis of pheochromocytoma. In this report, we describe a rare case of a symptomatic pheochromocytoma with normal catecholamine levels. Our case illustrates that routine nuclear scintigraphy, such as $^{131}I$-MIBG, should be performed even in cases with normal hormonal testing for all patients with high clinical suspicion of pheochromocytoma.
Keywords
3-iodobenzylguanidine; Catecholamines; Pheochromocytoma;
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