Acute Watery Diarrhea as the Initial Presenting Feature of a Pheochromocytoma in an 84-Year-Old Female Patient

Vol. 52, No. 2, 1999

Free Abstract Article (Fulltext) Article (PDF 397 KB)

Case Report

Acute Watery Diarrhea as the Initial Presenting Feature of a Pheochromocytoma in an 84-Year-Old Female Patient
Pascal Van Eeckhout^a, Hélène Shungu^d, François-Xavier Descamps^d, Philippe Lanthier^d, Thierry Castelain^d, Jean-Pierre Saey^b, Roland Rettman^b, Christian Drese^c, Ides M. Colin^d

^aUnit of Pathology,
^bDepartment of Surgery,
^cUnit of Anesthesiology, and
^dDepartment of Internal Medicine, CHR-St Joseph Medical Center, Mons, Belgium

Address of Corresponding Author

Horm Res 1999;52:101-106 (DOI: 10.1159/000023443)

Key Words

Pheochromocytoma
Vasoactive intestinal peptide
Diarrhea
Catecholamines
Verner-Morrison syndrome

Abstract

We report the case of an 84-year-old woman who was initially admitted to the emergency room of our institution for frank dehydration caused by acute and severe secretory diarrheas along with acidosis and hypokalemia. After extensive gastrointestinal investigations, the etiology of the diarrhea remained unclear. Because clinical symptoms and ionogram parameters worsened, despite intravenous fluids and electrolyte replacement, an abdominal CT scan was performed and unexpectedly revealed a 4.5-cm mass in the right adrenal gland. Several separate 24-hour urine catecholamines were shown to be highly elevated. The diagnosis of pheochromocytoma was confirmed by MIBG scintigraphy and MRI. Before the admission, the patient never experienced symptoms suggestive of pheochromocytoma, except dry mouth and fear of impending death on several occasions. After 2 weeks, the diarrhea stopped abruptly and spontaneously without specific medication but after adequate rehydration. The patient subsequently underwent surgical removal of the adrenal medullary mass. Postoperatively, urinary catecholamines returned to normal values. Immunohistochemical study of the tumor confirmed the diagnosis of pheochromocytoma and revealed the presence of VIP-positive cells organized as islets in scattered areas of the tissue. This case illustrates the protean mode of presentation of pheochromocytoma, as well as the ability of medullary neural crest-derived cells to produce various neuropeptides potentially responsible for a large variety of symptoms.

Author Contacts

Ides M. Colin, MD, PhD, Division of Endocrinology
Department of Internal Medicine, CHR-St Joseph Medical Center-Mons
5, Av. Baudouin de Constantinople, B-7000 Mons (Belgium)
Tel. +32 65 385 675, Fax +32 65 385 564
E-Mail colin@diab.ucl.ac.be

Article Information

Received: Received: April 1, 1999
Accepted after revision: July 29, 1999
Number of Print Pages : 6
Number of Figures : 6, Number of Tables : 1, Number of References : 21

Medline Abstract (ID 10681641)

Download Citation

Title change 2010 to:

This journal is part of the third subject package of the Karger

Journal Archive Collection

Information on packages (PDF)
Free sample issues

For non-native English speakers and international authors who would like assistance with their writing before submission, we suggest American Journal Experts for their scientific editing service.