Pheochromocytoma presenting with abdominal pain and predominant norepinephrine secretion in a young adult Nigerian: A case report

Abstract

Background: Pheochromocytoma is a rare neuroendocrine tumour of adrenal chromaffin cells, accounting for a tiny proportion of hypertension cases and adrenal masses. The neoplasm is commoner in the fourth and fifth decades of life but can uncommonly occur in younger people. In sporadic cases, abdominal pain can be an infrequent clinical presentation. With variable quantities of norepinephrine, pheochromocytoma primarily secretes epinephrine.

Case Presentation: A 25-year-old male with left flank pain, hypertension, and weight loss presented to our endocrinology outpatient clinic. Physical examinations revealed tachycardia, hypertension, and tenderness in the left flank. Urinalysis revealed glucosuria, proteinuria, ketonuria, and haematuria. Urinary and plasma catecholamines were markedly elevated (predominantly norepinephrine). An abdominal ultrasound revealed a mass in the left upper quadrant, with no metastasis or invasion. Post-admission, he struggled with poor glycaemic and blood pressure control. He was placed on basal bolus insulin therapy and antihypertensives. He underwent an exploratory laparotomy and left adrenalectomy, and has been in remission.

Conclusion: Persistent or resistant hypertension in a young adult accompanied by abdominal pain and hyperglycaemia should prompt consideration of pheochromocytoma, as recognising this pattern is crucial for timely biochemical testing and definitive diagnosis.