Bladder Pheochromocytoma Presented as Thunderclap Headache Triggered by Urination and Angina Pectoris

Article information

Kosin Med J. 2013;28(2):161-165

Publication date (electronic) : 2013 January 19

doi : https://doi.org/10.7180/kmj.2013.28.2.161

You Jin Han , Ho Sik Shin , Yeon Soon , Jung Hark Rim , So Young Ock , Eun Jeong Kim

Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding author: Ho Sik Shin, Department of Internal Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6108 FAX: +82-51-248-5686 E-mail: danieljoseph@hanmail.net

Received 2013 July 11; 2013 November 12; Accepted 2013 December 11.

Abstract

Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis, and angina pectoris. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by urination and angina pectoris as an initial manifestation. This case study suggests that thunderclap headache and angina pectoris occurring concurrently with sudden blood pressure elevation during or immediately after urination are important diagnostic clues of bladder pheochromocytoma.

Keywords: Angina pectoris; Pheochromocytoma; Thunderclap headache; Urination

Fig. 1.

Abdominal CT showed an intraluminal polypoid mass of approximately 3 × 3.2 cm in size with heterogeneous enhancement at the left lateral wall of the urinary bladder.

Fig. 2.

131I-MIBGs can showed partial uptake in the left side of the urinary bladder, which is consistent with pheochromocytoma.

Fig. 3.

Macroscopically, the pheochromocytoma was a 3 × 3.2-cm sized mass abutting from the left wall of the urinary bladder.

Fig. 4.

Immunohistochemical analysis revealed that the tumor cells were positive for chromogranin A staining (× 100).

References

1. Whalen RK, Althausen AF, Daniels GH. Extra-adrenal pheochromocytoma. J Urol 1992;147:1–10.

2. Gifford RW Jr, Manger WM, Bravo EL. Pheochromocytoma. Endocrinol Metab Clin North Am 1994;23:387–404.

3. Thompson LD. Pheochromocytoma of the Adrenal gland Scaled Score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol 2002;26:551–66.

4. Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med 2001;134:315–29.

5. Bourne RB, Beltaos E. Pheochromocytoma of the bladder: case report and summary of literature. J Urol 1967;98:361–4.

6. Farley SE, Smith CL. Unusual location of pheochromocytoma in the urinary bladder. J Urol 1959;81:130–2.

7. Kappers MH, van den Meiracker AH, Alwani RA, Kats E. Baggen MG. Paraganglioma of the urinary bladder. Neth J Med 2008;66:163–5.

8. Choi EK, Kim WH, Park KY. A case of a composite adrenal medullary tumor of pheochromocytoma and ganglioneuroma masquerading as acute pancreatitis. Korean J Intern Med 2006;21:141–5.

9. Tazi MF, Ahallal Y, Tazi E, Benlemlih A, Chbani L, Amarti A, et al. Pheochromocytoma of the urinary bladder: a case report. Cases J 2009;2:8585.

10. Seki N, Mukai S, Gamachi A, Migita T, Maeda K, Ogata N. A case of bladder pheochromocytoma. Urol Int 2001;66:57–60.

Article information Continued

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.