Pheochromocytoma diagnosed after anticoagulation for atrial fibrillation ablation procedure: a giant in disguise.

Abstract	Pheochromocytoma is a rare catecholamine-producing tumor, discovered incidentally in 50% of cases. We present the case of a 44-year-old male with a history of paroxysmal palpitations. Baseline ECG, transthoracic echocardiogram and ECG stress test showed no relevant alterations. Paroxysmal atrial fibrillation was detected on 24-hour Holter ECG. After antiarrhythmic therapy, the patient remained symptomatic, and was accordingly referred for electrophysiological study and atrial fibrillation ablation. Anticoagulation was initiated before the procedure. After ablation and still anticoagulated, he complained of hematospermia. The abdominal and pelvic imaging study showed a 10-cm left adrenal mass, predominantly cystic, compatible with pheochromocytoma, which was confirmed after biochemical tests (increased urine metanephrines and plasma catecholamines). Metaiodobenzylguanidine scintigraphy scanning confirmed localized disease in the adrenal gland, excluding other uptake foci. Following appropriate preoperative management, surgical resection of the giant mass was performed successfully and without complications.
Authors	Carlos Galvão Braga, Sílvia Ribeiro, Juliana Martins, Carina Arantes, Vítor Ramos, João Primo, Sónia Magalhães, Adelino Correia
Journal	Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology (Rev Port Cardiol) Vol. 33 Issue 4 Pg. 245.e1-4 (Apr 2014) ISSN: 2174-2030 [Electronic] Portugal
PMID	24780129 (Publication Type: Case Reports, Journal Article)
Copyright	Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Chemical References	Anticoagulants
Topics	Adrenal Gland Neoplasms (complications, diagnosis) Adult Anticoagulants (therapeutic use) Atrial Fibrillation (complications, surgery) Catheter Ablation Humans Incidental Findings Male Pheochromocytoma (complications, diagnosis)

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