A 34-year-old male smoker, 15 cigarettes a day, with a history of peptic arthritis, hiatal hernia and non-allergic bronchial asthma.
Diabetic Foot.
Severe abdominal pain in the left flank, pasty stools and increased abdominal sounds, which is assessed in primary care initially interpreting the picture as a possible acute gastroenteritis.
Physical examination revealed mild pain in the left hemiabdomen and slight increase in peristalsis.
Persistence of pain is required several complementary tests.
While a new evaluation is pending, 10 days after his visit to primary care, he comes to the hospital emergency department for presenting again an episode of intense abdominal pain in the left flank, accompanied by diaphoresis and cutaneous nervousness.
On three occasions, the patient was diagnosed and treated for renal colic.
Blood pressure 136/95 mm Hg; heart rate 89 l/min; temperature 37.7o; sweating.
Abdominal examination revealed left flank pain with positive left renal succupation.
The rest of the physical examination is normal.
Chest and abdominal X-rays are normal.
Minimal leukocytosis (10,500), mild hyponatremia and CRP=13 were observed.
As there was no clinical improvement with symptomatic treatment, ultrasound was performed with non-pelvic adrenocortical region showing a tumor in the left adrenal gland.
After this result a CAT scan was requested, which showed a 6.5 cm diameter mass dependent on the left adrenal gland, which suggested a differential diagnosis between pheochromocytoma or adrenal carcinoma.
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After this result, she was referred to the Urology Department and from this to Internal Medicine for functional study, in an attempt to rule out pheochromocytoma.
The determination of metanephrines and catechiae in urine shows a reading of more than five times the normal value for total metanephrines in urine and for urinary free catechiae.
A functioning left adrenal mass was diagnosed, with marked elevation of metanephrines due to probable pheochromocytoma.
Once the diagnosis of pheochromocytoma was integrated, it was decided to perform a total left laparoscopic adrenalectomy prior to blockade with 2azoxin 4 mg/day.
Anatomopathological analysis of surgical findings shows that it is a malignant chromatocytoma of 130 g and 6 x 6 cm, with extensive necrosis, marked pleomorphous cell invasion x 10 gauge renal vein thrombosis without tumor extension (<50).
The transoperative period was uneventful.
During the whole process the patient presents normal blood pressure levels with good general condition, and no treatment is carried out.
