Abstract
We report the case of a 67-year-old woman withsevere hypertension caused by an extra-adrenal pheochromocytoma.The tumor was detected by 131I metaiodobenzylguanidinescintigraphy and it was found to be small (2 cm ΓΈ) by enhanced CT. After the extirpation of the tumor, the blood pressure ofthe patient immediately normalized. It should be taken into accountthat a small extra-adrenal pheochromocytoma can be one of the causesof secondary hypertension in elderly patients. Since small extra-adrenal pheochromocytomasare difficult to detect, it is also important to perform suitableexaminations to establish the diagnosis. Furthermore, we emphasizethe importance of an accurate diagnosis in elderly patients with pheochromocytoma,for they often have less symptomatology and more severe cardiovascularcomplications due to refractory hypertension than younger patients.
Similar content being viewed by others
Article PDF
References
Manger WM, Gifford RW Jr : Pheochromocytoma. New York, Springer-Verlag, 1977.
Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T : Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004; 27: 193β202.
Bravo EL : Pheochromocytoma: new concepts and future trends (clinical conference). Kidney Int 1991; 40: 544β556.
Keiser HR, Doppman JL, Robertson CN, Linehan WN, Averbuch SD : Diagnosis, localization, and management of pheochromocytoma, in Lack EE ( ed): Pathology of the Adrenal Glands. New York, Churchill Livingstone, 1990, pp 237β255.
Staessen JA, Li Y, Thijs L, Wang JG : Blood pressure reduction and cardiovascular prevention: an update including the 2003β2004 secondary prevention trials. Hypertens Res 2005; 28: 385β407.
JATOS Study Group: The Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS): protocol, patient characteristics, and blood pressure during the first 12 months. Hypertens Res 2005: 28: 513β520.
Lenders JW, Eisenhofer G, Mannelli M, Pacak K : Phaeochromocytoma. Lancet 2005; 366: 665β675.
Kita T, Imamura T, Date H, et al: Two cases of pheochromocytoma associated with tetralogy of Fallot. Hypertens Res 2003; 26: 433β437.
Cooper ME, Goodman D, Frauman A, et al: Phaeochromocytoma in the elderly: a poorly recognized entity? Br Med J 1986; 293: 1474β1475.
Anderson GH Jr, Blackman N, Stressen DH : The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients. J Hypertens 1994; 12: 609β615.
Sutton MG, Sheps SG, Lie JT : Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc 1981; 56: 354β360.
Eisenhofer G, Lenders JW, Linehan WM, Walther MM, Goldstein DS, Keiser HR : Plasma normetanephrine and metanephrine for detecting pheochromocytoma in von Hippel-Lindau disease and multiple endocrine neoplasia type 2. N Engl J Med 1999; 340: 1872β1879.
Dluhy RG : Uncommon forms of secondary hypertension in older patients. Am J Hypertens 1998; 11: 52Sβ56S.
Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS : Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med 2001; 134: 315β329.
Williams DT, Dann S, Wheeler MH : Phaeochromocytomaβviews on current management. Eur J Surg Oncol 2003; 29: 483β490.
Lack EE, Cubilla AL, Woodruff JM, Lieberman PH : Extra-adrenal paragangliomas of the retroperitoneum. A clinicopathologic study of 12 tumors. Am J Surg Pathol 1980; 4: 109β120.
Sclafani LM, Woodruff JM, Brennan MF : Extra-adrenal retroperitoneal paragangliomas: natural history and response to treatment. Surgery 1990; 108: 1124β1130.
Kohane DS, Ingelfinger JR, Nimkin K, Wu CL : Case 16β2005βA nine-year-old girl with headaches and hypertension. New Engl J Med 2005; 352; 2223β2231.
Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF : Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab 2005; 90: 2110β2116.
Mori S, Okura T, Kitami Y, et al: A case of metastatic extra-adrenal pheochromocytoma 12 years after surgery. Hypertens Res 2002; 25: 141β144.
Mannelli M, Ianni L, Cilotti A, Conti A : Pheochromocytoma in Italy: a multicentric retrospective study. Eur J Endocrinol 1999; 141: 619β624.
Maurea S, Cuocolo A, Reynolds JC, et al: Iodine-131βmetaiodobenzylguanidine scintigraphy in preoperative and postoperative evaluation of paragangliomas: comparison with CT and MRI. J Nucl Med 1993; 34: 173β179.
Quint LE, Glazer GM, Francis IR, Shapiro B, Chenevert TL : Pheochromocytoma and paragangliomas: comparison of MR imaging with CT and I-131 MIBG scintigraphy. Radiology 1987; 165: 89β93.
Shulkin BL, Shapiro B, Francis IR, Dorr R, Shen SW, Sisson JC : Primary extra-adrenal pheochromocytoma: positive 123I MIBG imaging with negative 131I MIBG imaging. Clin Nucl Med 1986; 11: 851β854.
Nakatani T, Hayama T, Uchida J, Nakamura K, Takemoto Y, Sugimura K : Diagnostic localization of extra-adrenal pheochromocytoma: comparison of 123I-MIBG imaging and 131I-MIBG imaging. Oncol Rep 2002; 9: 1225β1227.
Katayama Y, Takata N, Tamura T, et al: A case of primary aldosteronism due to unilateral adrenal hyperplasia. Hypertens Res 2005; 28: 379β384.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mizuta, E., Hamada, T., Taniguchi, Si. et al. Small Extra-Adrenal Pheochromocytoma Causing Severe Hypertension in an Elderly Patient. Hypertens Res 29, 635β638 (2006). https://doi.org/10.1291/hypres.29.635
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.29.635