Adrenal (Excluding Mineralocorticoids)

SAT-495 - Beyond the Classic Triad: A Case Report of Normotensive Pheochromocytoma

Saturday, June 13, 2026

9:30 AM - 4:30 PM CT

Location: ENDOExpo; Poster Floor

Abstract Poster Presenter(s)

Caeralyne Capuno Memoracion, MD, MPH

USTH
Zamboanga, Philippines

Co-Author(s)

JL

Jo Rocel Lacson, MD

University of Santo Tomas Hospital
Manila, National Capital Region, Philippines
DB

Dionise Ysabelle Bawal, MD

University of Santo Tomas Hospital
Manila, National Capital Region, Philippines
MA

Marie Chris Amador-Pedregoza, MD

University of Santo Tomas Hospital
Manila, National Capital Region, Philippines
PA

Paul John Ablaza, MD

University of Santo Tomas Hospital
Manila, National Capital Region, Philippines

Disclosure(s):

Caeralyne Capuno Memoracion, MD, MPH: No financial relationships to disclose

Background: Pheochromocytoma can present without sustained hypertension or classic adrenergic symptoms, and catecholamine results may be only borderline abnormal. We report a normotensive young woman in whom imaging and clinical course guided perioperative preparation despite equivocal biochemistry.

CASE SUMMARY: A 22-year-old woman with no comorbidities presented with 4-day progressive left upper quadrant pain radiating to the left scapula, with intermittent vomiting and undocumented fever. She remained normotensive and had no headache, palpitations, or diaphoresis. Initial work-up favored gastrointestinal and infectious causes; labs showed mild anemia with reactive thrombocytosis and intermittent leukocytosis. CT demonstrated a 5.0 × 4.5 × 4.0 cm heterogeneously enhancing left adrenal mass with central necrosis. Endocrine evaluation showed a borderline elevated 24-hour urinary metanephrine of 1.38 mg/24 h (reference 0–1.0 mg/24 h) and a mildly nonsuppressed post–dexamethasone suppression cortisol of 2.33 µg/dL (reference < 1.8 µg/dL). Despite equivocal biochemistry and absence of hypertension, pheochromocytoma was suspected based on imaging and clinical course. Preoperative alpha-adrenergic blockade was initiated, and the patient underwent open left adrenalectomy. Marked intraoperative blood pressure lability occurred, including episodes of severe hypertension requiring vasodilator therapy. Histomorphology with supportive immunohistochemical staining confirmed pheochromocytoma. She recovered without complications and was discharged in stable condition with close outpatient follow-up.

Conclusion: Normotension and borderline biochemical elevations do not exclude pheochromocytoma. When imaging is suggestive, maintaining diagnostic suspicion and instituting appropriate preoperative blockade are critical to reduce perioperative hemodynamic complications.

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