MON-534 - Dual Challenge: Managing Pheochromocytoma and Concurrent Diabetes Mellitus in A Patient Presenting with Severe Hypertension and Hyperglycemia.

Background:
Pheochromocytoma is a rare catecholamine secreting tumor that can precipitate hypertensive crises and metabolic instability. Its coexistence with type 1 diabetes mellitus (T1DM) adds complexity, as catecholamine excess worsens hyperglycemia, predisposes to recurrent diabetic ketoacidosis (DKA), and increases cardiovascular risk. Early recognition and coordinated management are critical to prevent life threatening complications.

Case Presentation:
A 41 year old patient with longstanding T1DM and recurrent DKA episodes presented with right sided chest pain, anorexia for 3–4 days, and severe hyperglycemia (blood glucose 454 mg/dL). On admission, the patient was diagnosed with DKA and non ST elevation myocardial infarction (NSTEMI), with blood pressure of 190/100 mmHg and tachycardia in the 100s. Despite standard DKA management, persistent hypertension and labile glycemic control prompted further evaluation. Urinary free metanephrines were markedly elevated at 1372 µg/24h, and imaging revealed a left adrenal mass consistent with pheochromocytoma. The patient was stabilized with alpha adrenergic blockade followed by beta blockade, and transitioned to insulin therapy for glycemic control. Due to comorbidities and cardiovascular risk, surgical intervention was deferred, and the patient remained on medical management with improved hemodynamic stability and better glycemic control.

Discussion:
This case illustrates the dual challenge of managing pheochromocytoma in a patient with T1DM. Catecholamine excess exacerbates hyperglycemia by impairing insulin secretion and promoting hepatic glucose output, while simultaneously driving severe hypertension and cardiovascular stress, as evidenced by concurrent NSTEMI. Recognition of atypical presentations is essential, particularly when hypertension and metabolic instability coexist. Multidisciplinary management — endocrinology, cardiology, and internal medicine — is vital for safe outcomes. Literature suggests that while adrenalectomy is curative, medical therapy can provide stabilization in patients who are not surgical candidates.

Conclusion:
Concurrent pheochromocytoma and T1DM can present with severe hypertension, hyperglycemia, and cardiovascular complications. Even in the absence of surgical intervention, timely diagnosis and integrated medical management are key to improving hemodynamic stability and metabolic control, underscoring the importance of vigilance in complex endocrine presentations.

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