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Reporte de caso
Medwave 2018;18(7):e7320 doi: 10.5867/medwave.2018.07.7320
Feocromocitoma en neoplasia endocrina múltiple IIA asociado a tuberculosis pulmonar presentada como abdomen agudo: reporte de caso y revisión de la literatura
Pheochromocytoma in multiple endocrine neoplasia 2A associated with pulmonary tuberculosis presenting as abdominal pain: a case report and literature review
José Lavalle-Martínez, Mario Suárez-Montalvo
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Palabras clave: multiple endocrine neoplasia type 2A, pheochromocytoma, abdominal pain, pulmonary tuberculosis

Abstract

Pheochromocytoma is a catecholamine-producing neoplasm that may occur sporadically or associated with hereditary diseases, such as multiple endocrine neoplasia. The classic symptoms are headache, sweating, and palpitations and are attributed to the sympathetic nervous system activity, usually presenting as paroxysms. On the other hand, pulmonary tuberculosis is an infectious disease considered a public health problem in many countries, whose incidence depends on risk factors such as immunosuppression. It is well known that endocrine-tumor diseases such as multiple endocrine neoplasia can predispose to chronic inflammation and immunosuppression. We report the case of a 38-year-old male patient who had an episode of arterial hypertension and abdominal pain as the first symptoms of a pheochromocytoma associated with multiple endocrine neoplasia type 2A. The patient developed pulmonary tuberculosis simultaneously, but we managed to treat both entities and achieve a favorable clinical course.


 

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Pheochromocytoma is a catecholamine-producing neoplasm that may occur sporadically or associated with hereditary diseases, such as multiple endocrine neoplasia. The classic symptoms are headache, sweating, and palpitations and are attributed to the sympathetic nervous system activity, usually presenting as paroxysms. On the other hand, pulmonary tuberculosis is an infectious disease considered a public health problem in many countries, whose incidence depends on risk factors such as immunosuppression. It is well known that endocrine-tumor diseases such as multiple endocrine neoplasia can predispose to chronic inflammation and immunosuppression. We report the case of a 38-year-old male patient who had an episode of arterial hypertension and abdominal pain as the first symptoms of a pheochromocytoma associated with multiple endocrine neoplasia type 2A. The patient developed pulmonary tuberculosis simultaneously, but we managed to treat both entities and achieve a favorable clinical course.

Autores: José Lavalle-Martínez[1], Mario Suárez-Montalvo[2]

Filiación:
[1] Departamento de Emergencias del Adulto, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
[2] Departamento de Medicina Interna, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú

E-mail: joselavallemartinez@gmail.com

Correspondencia a:
[1] Jirón Edgardo Rebagliati 490
Distrito de Jesús María
Ciudad de Lima
Perú

Citación: Lavalle-Martínez J, Suárez-Montalvo M. Pheochromocytoma in multiple endocrine neoplasia 2A associated with pulmonary tuberculosis presenting as abdominal pain: a case report and literature review. Medwave 2018;18(7):e7320 doi: 10.5867/medwave.2018.07.7320

Fecha de envío: 18/7/2018

Fecha de aceptación: 5/10/2018

Fecha de publicación: 9/11/2018

Origen: no solicitado

Tipo de revisión: con revisión por cuatro pares revisores externos, a doble ciego

Ficha PubMed

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  1. Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354-60. | PubMed |
  2. Else T. 15 YEARS OF PARAGANGLIOMA: Pheochromocytoma, paraganglioma and genetic syndromes: a historical perspective. Endocr Relat Cancer. 2015 Aug;22(4):T147-59. | CrossRef | PubMed |
  3. Rodriguez JM, Balsalobre M, Ponce JL, Ríos A, Torregrosa NM, Tebar J, Parrilla P. Pheochromocytoma in MEN 2A syndrome. Study of 54 patients. World J Surg. 2008 Nov;32(11):2520-6. | CrossRef | PubMed |
  4. Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore). 1991 Jan;70(1):46-66. | PubMed |
  5. Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. | PubMed |
  6. Raue F, Frank-Raue K, Grauer A. Multiple endocrine neoplasia type 2. Clinical features and screening. Endocrinol Metab Clin North Am. 1994 Mar;23(1):137-56. | PubMed |
  7. Evans JP, Bambach CP, Andrew S, Dwight T, Richardson AL, Robinson BG, et al. MEN type 2a presenting as an intra-abdominal emergency. Aust N Z J Surg. 1997 Nov;67(11):824-6. | PubMed |
  8. Webb TA, Sheps SG, Carney JA. Differences between sporadic pheochromocytoma and pheochromocytoma in multiple endocrime neoplasia, type 2. Am J Surg Pathol. 1980 Apr;4(2):121-6. | PubMed |
  9. Modigliani E, Vasen HM, Raue K, Dralle H, Frilling A, Gheri RG, et al. Pheochromocytoma in multiple endocrine neoplasia type 2: European study. The Euromen Study Group. J Intern Med. 1995 Oct;238(4):363-7. | PubMed |
  10. Thosani S, Ayala-Ramirez M, Palmer L, Hu MI, Rich T, Gagel RF, et al. The characterization of pheochromocytoma and its impact on overall survival in multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 2013 Nov;98(11):E1813-9. | CrossRef | PubMed |
  11. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014 Jun;99(6):1915-42. | CrossRef | PubMed |
  12. Pomares FJ, Cañas R, Rodriguez JM, Hernandez AM, Parrilla P, Tebar FJ. Differences between sporadic and multiple endocrine neoplasia type 2A phaeochromocytoma. Clin Endocrinol (Oxf). 1998 Feb;48(2):195-200. | PubMed |
  13. Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610. | CrossRef | PubMed |
  14. Kinlaw WB, Scott SM, Maue RA, Memoli VA, Harris RD, Daniels GH, et al. Multiple endocrine neoplasia 2A due to a unique C609S RET mutation presents with pheochromocytoma and reduced penetrance of medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2005 Dec;63(6):676-82. | PubMed |
  15. Alarcón V, Alarcón E, Figueroa C, Mendoza-Ticona A. [Tuberculosis in Peru: epidemiological situation, progress and challenges for its control]. Rev Peru Med Exp Salud Publica. 2017 Apr-Jun;34(2):299-310. | CrossRef | PubMed |
  16. Roth GM, Flock EV, Bollman JL, Kvale WF. Evaluation of the pharmacologic and chemical tests as an aid to diagnosis of pheochromocytoma. Angiology. 1959 Dec;10:426-30. | PubMed |
  17. Toure P, Leye A, Leye Y, Diop M, Diop M, Elfajri S, et al. Metastases Of Pheochromocytoma Or Multifocal Tuberculosis? Difficulty Of Diagnosis, A Case Report. The Internet Journal of Endocrinology. 2010;6(2):1-4 | Link |
  18. KA, Shankar SV, UG. Coexistent extra adrenal pheochromocytoma and extrapulmonary tuberculosis: a case report and review of literature. J Clin Diagn Res. 2012 Oct;6(8):1430-2. | CrossRef | PubMed |
Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354-60. | PubMed |

Else T. 15 YEARS OF PARAGANGLIOMA: Pheochromocytoma, paraganglioma and genetic syndromes: a historical perspective. Endocr Relat Cancer. 2015 Aug;22(4):T147-59. | CrossRef | PubMed |

Rodriguez JM, Balsalobre M, Ponce JL, Ríos A, Torregrosa NM, Tebar J, Parrilla P. Pheochromocytoma in MEN 2A syndrome. Study of 54 patients. World J Surg. 2008 Nov;32(11):2520-6. | CrossRef | PubMed |

Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore). 1991 Jan;70(1):46-66. | PubMed |

Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. | PubMed |

Raue F, Frank-Raue K, Grauer A. Multiple endocrine neoplasia type 2. Clinical features and screening. Endocrinol Metab Clin North Am. 1994 Mar;23(1):137-56. | PubMed |

Evans JP, Bambach CP, Andrew S, Dwight T, Richardson AL, Robinson BG, et al. MEN type 2a presenting as an intra-abdominal emergency. Aust N Z J Surg. 1997 Nov;67(11):824-6. | PubMed |

Webb TA, Sheps SG, Carney JA. Differences between sporadic pheochromocytoma and pheochromocytoma in multiple endocrime neoplasia, type 2. Am J Surg Pathol. 1980 Apr;4(2):121-6. | PubMed |

Modigliani E, Vasen HM, Raue K, Dralle H, Frilling A, Gheri RG, et al. Pheochromocytoma in multiple endocrine neoplasia type 2: European study. The Euromen Study Group. J Intern Med. 1995 Oct;238(4):363-7. | PubMed |

Thosani S, Ayala-Ramirez M, Palmer L, Hu MI, Rich T, Gagel RF, et al. The characterization of pheochromocytoma and its impact on overall survival in multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 2013 Nov;98(11):E1813-9. | CrossRef | PubMed |

Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014 Jun;99(6):1915-42. | CrossRef | PubMed |

Pomares FJ, Cañas R, Rodriguez JM, Hernandez AM, Parrilla P, Tebar FJ. Differences between sporadic and multiple endocrine neoplasia type 2A phaeochromocytoma. Clin Endocrinol (Oxf). 1998 Feb;48(2):195-200. | PubMed |

Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610. | CrossRef | PubMed |

Kinlaw WB, Scott SM, Maue RA, Memoli VA, Harris RD, Daniels GH, et al. Multiple endocrine neoplasia 2A due to a unique C609S RET mutation presents with pheochromocytoma and reduced penetrance of medullary thyroid carcinoma. Clin Endocrinol (Oxf). 2005 Dec;63(6):676-82. | PubMed |

Alarcón V, Alarcón E, Figueroa C, Mendoza-Ticona A. [Tuberculosis in Peru: epidemiological situation, progress and challenges for its control]. Rev Peru Med Exp Salud Publica. 2017 Apr-Jun;34(2):299-310. | CrossRef | PubMed |

Roth GM, Flock EV, Bollman JL, Kvale WF. Evaluation of the pharmacologic and chemical tests as an aid to diagnosis of pheochromocytoma. Angiology. 1959 Dec;10:426-30. | PubMed |

Toure P, Leye A, Leye Y, Diop M, Diop M, Elfajri S, et al. Metastases Of Pheochromocytoma Or Multifocal Tuberculosis? Difficulty Of Diagnosis, A Case Report. The Internet Journal of Endocrinology. 2010;6(2):1-4 | Link |

KA, Shankar SV, UG. Coexistent extra adrenal pheochromocytoma and extrapulmonary tuberculosis: a case report and review of literature. J Clin Diagn Res. 2012 Oct;6(8):1430-2. | CrossRef | PubMed |