A case of catecholamine crisis induced by iatrogenic glucocorticoids: case report

Background: Pheochromocytoma is a rare neuroendocrine tumor originating from chromaffin cells in the adrenal medulla, and is a rare type of secondary hypertension. It mainly synthesizes and secretes excessive catecholamines, causing a series of clinical symptoms, such as headache, sweating, palpitations, and may be life-threatening in severe cases. In the current case report, we describe a rare case of a clinically manifesting pheochromocytoma with which landed in pheochromocytoma crisis. Case presentation: The authors describe a rare case of a clinically manifesting pheochromocytoma with which landed in pheochromocytoma. A 19-year-old female was admitted with headache, recurrent nausea and vomiting, and fever. The patient's levels of troponin I and BNP increased after using glucocorticoids. And the patient continued to be treated with glucocorticoids due to misdiagnosis as myocarditis. Computerized tomography exposed a soft tissue density mass at the left adrenal gland. Further evaluations revealed high levels of plasma catecholamines and 24-hour urine catecholamines and their metabolites. The patient was clinically diagnosed with pheochromocytoma and discontinued glucocorticoids. RET Cys634Arg mutation was found in this case. After 3 months of preparation, the patient underwent surgical. The patient was discharged from hospital without further medication. The patient was followed-up regularly after surgery and did not experience any of the above symptoms. Conclusion: Glucocorticoids can induce crisis in pheochromocytoma. Therefore, before starting therapeutic glucocorticoids, any clinical signs or symptoms of a potential pheochromocytoma or adrenal accidental tumors should prompt reliable biochemical testing to rule out a pheochromocytoma.