Abstract
Objective: To describe a case of hypertensive emergency following embolization of a large myelolipoma. Methods: Using the case report format to present clinical, laboratory, imaging, and dynamic testing data supporting clinical decision making. This is accompanied by a literature review. Results: A 40-year-old male with a history of hypertension presented with acute right upper abdominal pain and shortness of breath. Imaging completed at the transferring facility revealed a large right adrenal mass encapsulating the inferior vena cava. The blood hemoglobin was 7.8 g/dL because of internal hemorrhage into the mass. He underwent embolization of arterial flow to the right adrenal mass. A hypertensive emergency developed, and endocrinology was consulted to evaluate for pheochromocytoma. The plasma and urine normetanephrine were elevated, but the corresponding metanephrines remained normal. Surgery was imminent, and a clonidine suppression test in the surgical intensive care unit resulted in 60% suppression of plasma norepinephrine concentrations. He was cleared for surgery. The pathologic findings confirmed giant myelolipoma with internal hemorrhage. Conclusion: A giant myelolipoma with compressive effects can mimic a pheochromocytoma. To support clinical decision making for short-notice surgical clearance, the clonidine suppression test proved to be a simple supplementary test to differentiate pheochromocytoma and hyperadrenergic state of critical illness.
Original language | English (US) |
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Pages (from-to) | e216-e220 |
Journal | AACE Clinical Case Reports |
Volume | 1 |
Issue number | 4 |
DOIs | |
State | Published - Sep 1 2015 |
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism