Atypical presentation of pheochromocytoma as acute ischemic stroke and pulmonary embolism, a case report

Abstract

Background: Pheochromocytoma is a rare catecholamine-secreting tumor that often presents with symptoms such as hypertension, palpitations, and sweating due to excessive hormone production. In some cases, the catecholamine-induced vasoconstriction and hypercoagulability associated with pheochromocytomas can lead to cerebrovascular accidents and venous thrombosis. We report a rare case of pheochromocytoma in a middle-aged man who initially presented with a stroke and later developed a pulmonary embolism.

Case Presentation: A 44-year-old gentleman presented with sudden right-sided weakness, numbness, and slurred speech, lasting for 6 h. His medical history included hypertension, for which he was on bisoprolol. On examination, he exhibited right-sided facial weakness, asymmetric smile, and motor weakness (0/5 on the right). Brain computed tomography angiography revealed an infarction in the left middle cerebral artery territory, complicated by hemorrhagic transformation. Seven days later, he developed severe left-sided abdominal and chest pain, sweating, and left upper quadrant tenderness. His labs showed leukocytosis, and chest radiography raised suspicion of pulmonary embolism (PE). A computed tomography (CT) pulmonary angiogram confirmed thrombi in the left lower lobe with moderate left pleural effusion. Abdominal ultrasound revealed a non-vascular mass near the left kidney, which was later identified as a 3.6 cm × 4.3 cm adrenal mass on CT. Biochemical tests confirmed pheochromocytoma. An FDG-PET scan suggested an intense FDG-avid left adrenal mass.

Conclusion: This case demonstrates the rare association between pheochromocytoma and thrombotic events. Atypical presentations can complicate diagnosis, highlighting the need for early testing. Surgery remains the primary treatment, with long-term follow-up due to the risk of recurrence.

Keywords

adrenal tumor / arterial thrombosis / catecholamines / ischemic stroke / pheochromocytoma

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