Case report: Incidentally discovered case of pheochromocytoma as a cause of long COVID-19 syndrome.

Pheochromocytomas (PCCs) are rare but potentially lethal tumors that arise from the adrenal medulla. The clinical suspicion and diagnosis of PCC can be challenging due to the non-specific nature of signs and symptoms. In many patients, infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could lead to long-term symptoms including fatigue, headaches, and cognitive dysfunction. Here, we present the case of a patient incidentally diagnosed with an adrenal mass that proved to be a PCC after imaging was performed due to persisting complaints after coronavirus disease 2019 (COVID-19) infection. A 37-year-old male patient was referred to our center because of a right-sided inhomogeneous adrenal mass, incidentally found during a computed tomographic scan of the thorax performed due to cough and dyspnea that persisted after COVID-19 infection. Other complaints that were present prior to COVID-19 infection included profuse sweating, dizziness, exhaustion with chronic fatigue, and concentration difficulties. The patient had no history of hypertension, his blood pressure was normal, and the 24-h ambulatory blood pressure monitoring confirmed normotension but with the absence of nocturnal dipping. Plasma normetanephrine was 5.7-fold above the upper limit (UL) of reference intervals (738 pg/ml, UL = 129 pg/ml), whereas plasma metanephrine and methoxytyramine were normal at 30 pg/ml (UL = 84 pg/ml) and <4 pg/ml (UL = 16 pg/ml), respectively. Preoperative preparation with phenoxybenzamine was initiated, and a 4-cm tumor was surgically resected. Profuse sweating as well as dizziness was resolved after adrenalectomy pointing toward PCC and not COVID-19-associated patient concerns. Altogether, this case illustrates the difficulties in recognizing the possibility of PCC due to the non-specific nature of signs and symptoms of the tumor, which in this case did not include hypertension and coincided with some of the symptoms of long COVID-19.
AuthorsChristian G Ziegler, Carina Riediger, Matthias Gruber, Carola Kunath, Martin Ullrich, Jens Pietzsch, Svenja Nölting, Timo Siepmann, Stefan R Bornstein, Hanna Remde, Georgiana Constantinescu
JournalFrontiers in endocrinology (Front Endocrinol (Lausanne)) Vol. 13 Pg. 967995 ( 2022) ISSN: 1664-2392 [Print] Switzerland
PMID36237184 (Publication Type: Case Reports, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2022 Ziegler, Riediger, Gruber, Kunath, Ullrich, Pietzsch, Nölting, Siepmann, Bornstein, Remde and Constantinescu.
Chemical References
  • Normetanephrine
  • Phenoxybenzamine
  • Metanephrine
  • Adrenal Gland Neoplasms (complications, diagnosis, surgery)
  • Adult
  • Blood Pressure Monitoring, Ambulatory
  • COVID-19 (complications)
  • Dizziness (complications)
  • Humans
  • Hypertension (complications)
  • Male
  • Metanephrine
  • Normetanephrine
  • Phenoxybenzamine
  • Pheochromocytoma (complications, diagnosis, surgery)
  • SARS-CoV-2
  • Post-Acute COVID-19 Syndrome

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