Diagnosis and Treatment > Medication
Search for other papers by Catherine Alguire in
Google Scholar
PubMed
Search for other papers by Jessica Chbat in
Google Scholar
PubMed
Search for other papers by Isabelle Forest in
Google Scholar
PubMed
Search for other papers by Ariane Godbout in
Google Scholar
PubMed
Search for other papers by Isabelle Bourdeau in
Google Scholar
PubMed
Summary
Pheochromocytoma is a rare tumor of the adrenal gland. It often presents with the classic triad of headache, palpitations and generalized sweating. Although not described as a typical symptom of pheochromocytoma, anxiety is the fourth most common symptom reported by patients suffering of pheochromocytoma. We report the case of a 64 year old man who had severe anxiety and panic disorder as presenting symptoms of pheochromocytoma. After 13 years of psychiatric follow-up, the patient was diagnosed with malignant pheochromocytoma. After surgical resection of his pheochromocytoma and his hepatic metastases, the major panic attacks completely disappeared, the anxiety symptoms improved significantly and the psychiatric medications were stopped except for a very low maintenance dose of venlafaxine. We found in our cohort of 160 patients with pheochromocytoma 2 others cases of apparently benign tumors with severe anxiety that resolved after pheochromocytoma resection. These cases highlight that pheochromocytoma should be included in the differential diagnosis of refractory anxiety disorder.
Learning points:
-
Anxiety and panic disorder may be the main presenting symptoms of pheochromocytoma.
-
The diagnosis of pheochromocytoma should be excluded in cases of long-term panic disorder refractory to medications since the anxiety may be secondary to a catecholamine-secreting tumor.
-
Surgical treatment of pheochromocytoma leads to significant improvement of anxiety disorders.
Search for other papers by Carlos Tavares Bello in
Google Scholar
PubMed
Search for other papers by Emma van der Poest Clement in
Google Scholar
PubMed
Search for other papers by Richard Feelders in
Google Scholar
PubMed
Summary
Cushing’s syndrome is a rare disease that results from prolonged exposure to supraphysiological levels of glucocorticoids. Severe and rapidly progressive cases are often, but not exclusively, attributable to ectopic ACTH secretion. Extreme hypercortisolism usually has florid metabolic consequences and is associated with an increased infectious and thrombotic risk. The authors report on a case of a 51-year-old male that presented with severe Cushing’s syndrome secondary to an ACTH-secreting pituitary macroadenoma, whose diagnostic workup was affected by concurrent subclinical multifocal pulmonary infectious nodules. The case is noteworthy for the atypically severe presentation of Cushing’s disease, and it should remind the clinician of the possible infectious and thrombotic complications associated with Cushing’s syndrome.
Learning points:
-
Severe Cushing’s syndrome is not always caused by ectopic ACTH secretion.
-
Hypercortisolism is a state of immunosuppression, being associated with an increased risk for opportunistic infections.
-
Infectious pulmonary infiltrates may lead to imaging diagnostic dilemmas when investigating a suspected ectopic ACTH secretion.
-
Cushing’s syndrome carries an increased thromboembolic risk that may even persist after successful surgical management.
-
Antibiotic and venous thromboembolism prophylaxis should be considered in every patient with severe Cushing’s syndrome.
