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Diagnosis of pheochromocytoma in the setting of Parkinson disease

Nature Reviews Neurology volume 5, pages 343–347 (2009)Cite this article

Abstract

Background. A 59-year-old man with a 7-year history of Parkinson disease (PD) presented with episodes of sudden, severe headaches with neck pain, tachycardia, sweating and pallor. During these episodes, the patient showed marked elevations in blood pressure, regardless of posture. This was unusual, given that he had no prior history of hypertension. The array of symptoms raised suspicions of pheochromocytoma, but diagnosis was challenging, as the standard diagnostic biochemical tests were confounded by dopaminergic medications. Further work-up revealed left adrenal medullary hyperplasia. Several reports exist of pseudopheochromocytoma in patients on dopaminergic therapy, but this is the first documented case of pheochromocytoma syndrome due to adrenal medullary hyperplasia in a patient with PD. This case highlights the challenges of performing a diagnostic work-up in a PD patient with symptoms suggestive of pheochromocytoma, and illustrates the utility of 123I-metaiodobenzylguanidine (123I-MIBG) single-photon emission CT in making a diagnosis.

Investigations. Physical examination, laboratory tests, abdominal MRI scan, abdominal 123I-MIBG scan, abdominal 18F-fluorodeoxyglucose PET scan.

Diagnosis. Pheochromocytoma syndrome due to adrenal medullary hyperplasia.

Management. Surgical excision of the left adrenal gland.

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Figure 1: Abdominal MRI scan from a patient with a suspected pheochromocytoma.
Figure 2: Abdominal 123I-metaiodobenzylguanidine single-photon emission CT scan from a patient with a suspected pheochromocytoma.

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Acknowledgements

The authors would like to thank Dr. Karel Pacak, Section Chief, Medical Neuroendocrinology at NIH, Bethesda, MD, USA for suggestions and comments during the preparation of this manuscript. Written consent for publication was obtained from the patient.

Charles. P. Vega, University of Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Neurology, Movement Disorders Program, Medical College of Georgia, Augusta, GA, USA,

    Shyamal H. Mehta, Rajan Prakash, John C. Morgan & Kapil D. Sethi

  2. Department of Internal Medicine and Cardiology, Medical College of Georgia, Augusta, GA, USA,

    L. Michael Prisant

  3. Department of Orthopedic Surgery, Medical College of Georgia, Augusta, GA, USA,

    Carlos M. Isales

  4. Department of Radiology, Medical College of Georgia, Augusta, GA, USA

    Hadyn Williams

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  1. Shyamal H. Mehta
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Correspondence to Shyamal H. Mehta.

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Mehta, S., Prakash, R., Prisant, L. et al. Diagnosis of pheochromocytoma in the setting of Parkinson disease. Nat Rev Neurol 5, 343–347 (2009). https://doi.org/10.1038/nrneurol.2009.55

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