TY - JOUR
T1 - Hypertensive Emergency Following Embolization of a Large Adrenal Myelolipoma–Adrenal Medullary Infarction, Pheochromocytoma, or Acute Sympathetic Discharge? A Case Report and Literature Review
AU - Ansari, Mohammed Z.
AU - De La Garza, Maria M.
AU - Deavers, Michael
AU - Balogh, Julius
AU - Rosenberg, Wade R.
AU - Hai, Shaikh
AU - Ruppe, Mary
AU - Hamilton, Dale J.
N1 - Funding Information:
We thank Melina Awar, for her assistance with clinical details and care of the patient, and Richard J. Robbins, for his insightful comments on the manuscript and case description. Both are from the Department of Medicine, Houston Methodist Hospital. We also thank Dr. Maren Fuller for taking the gross photographs of the tumor.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - 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.
AB - 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.
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U2 - 10.4158/EP14539.CR
DO - 10.4158/EP14539.CR
M3 - Article
AN - SCOPUS:85124220115
VL - 1
SP - e216-e220
JO - AACE Clinical Case Reports
JF - AACE Clinical Case Reports
SN - 2376-0605
IS - 4
ER -