A case of pheochromocytoma presenting as secondary hyperaldosteronism, hyperparathyroidism, diabetes and proteinuric renal disease

Abstract

A 35-year-old woman was admitted to the Nephrology and Dialysis Unit of Pisa University for hypertension, hypokalaemia, renal impairment, proteinuria and hyperglycaemia. plasma renin activity (PRA) and plasma aldosterone were elevated, but Doppler ultrasound and angio-computed tomography (CT) of renal arteries were normal. Abdomen CT revealed only a left adrenal mass, and measurement of catecholamines suggested the diagnosis of pheochromocytoma. Biochemical findings suggestive of hyperparathyroidism were also detected, but a multiple endocrine disorder was excluded by genetic analysis. Pathology examination confirmed the pheochromocytoma and immunohistochemistry also showed positivity for parathyroid hormone. After surgery, disappearance of the symptoms and normalization of all haemodynamic and humoral parameters was observed. This is a rare case of pheochromocytoma responsible for secondary hyperaldosteronism, hyperparathyroidism, proteinuric renal disease and diabetes mellitus.

Phaeochromocytoma with hypercortisolism and hypercalcaemia

“…Hypercalcaemia associated with phaeochromocytoma has been documented and thought to be caused by the production of PTH or PTHrP by the tumour 2 8 9. The low preoperative blood levels of PTH and PTHrP suggest an alternative (but as yet unexplained) cause of hypercalcaemia in this patient.…”

“…However, since ectopic hormone secretion has implications for management in the perioperative period, prompt identification and appropriate management is important. Most often, only one additional hormone is secreted and this has been reported in a few case studies; the most common reported clinical association has been with hypercortisolism 1 2. This is thought to be due to either adrenocorticotropic hormone (ACTH) or corticotrophin releasing hormone (CRH) co-secretion.…”

Renin and Aldosterone Measurements in the Management of Arterial Hypertension

“…True HRH has been observed in a minority of the hypertensive population [10], although about 70 % of patients fall into the group with "non-suppressed" renin values [10]. The main secondary causes of hypertension, which present with elevated renin levels are renovascular hypertension [20], pheochromocytoma [21,22], and hypertension related to oral contraceptive assumption [23] ( • ▶ Table 1). A very rare condition is reninsecreting juxtaglomerular cells tumor, or reninoma [24].…”

Mineralocorticoid functional of adrenal cortex in patients with pheochromocytoma

“…Ряд авторов рассматривают надпочечник как единую функциональную структуру, в которой клетки коркового и мозгового вещества активно взаимодействуют между собой, способствуя стимуляции синтеза минералкортикоидов клетками коркового слоя [14]. Наличие гиперальдостеронизма и ФХ возможно и при развитии в одном надпочечнике двух гормонально активных опухолей в различных слоях, например, при сочетании ФХ и альдостеронпродуцирующей аденомы или гиперплазии коры надпочечников [15][16][17]. Таким образом, остается много вопросов в понимании механизмов повреждения альдостерон-рениновой системы у больных с ФХ, что вызывает огромный интерес к изучению этой проблемы.…”