Pheochromocytoma: Case Report with Certain Observations on the Pathologic Physiology

Abstract

A case of pheochromocytoma of the right adrenal medulla was reported in which the most prominent feature was paroxysmal hypertension, accompanied by symptoms of marked sympathicotonia. Paroxysms occasionally ended in major convulsions. In addition to episodic attacks, there were constant tachycardia, tremor, and polyphagia with a tendency toward wt. loss. Blood pressure and BMR detns. were normal between attacks. The only constant precipitating factor for episodes was hyperventilation, which invariably induced attacks. This factor was used in determining in detail certain physical and chemical changes during induced paroxysms. Surgical removal of the tumor was followed by intractable shock and death. This shock was remarkable in that it responded only to large amts. of intravenous adrenalin. Biologic assay of the fluid from the tumor indicated that it contained high concns. of a substance which was indistinguishable from adrenalin. However, the fact that the pressor effect of this fluid was present in un-diminished potency 48 hrs. post-operatively suggested that a more stable substance than adrenalin, such as tyrosine, was present in this particular tumor. Striking electro-cardio-graphic changes during a paroxysm were interpreted as indicative of strong compensatory vagal response to sudden hypertension. It was felt that preoperative localization of such a tumor is desirable in spite of the untoward reactions which have been reported in connection with certain special X-ray examinations, such as retrograde pyelography, and perirenal air insufflation.