Stroke secondary to hypertension as initial presentation in pheochromocytoma: a case report

Abstract

Pheochromocytoma presenting with stroke as the initial presentation is rare and carries a high mortality rate. Early detection is essential to prevent the attendant life-threatening effects. There is no algorithmic approach in diagnosing and managing this condition due to a lack of evidence-based guidelines and randomized  control studies. The objective of this study was to analyze the prevalence of pheochromocytoma among patients presenting with secondary hypertension and stroke and to identify the diagnostic challenges and the outcome of a patient with pheochromocytoma-associated secondary hypertension presenting with stroke. This is a retrospective study of a 54-year-old male presenting with stroke and hypertensive crisis diagnosed with pheochromocytoma. He had complaints of sudden left- sided weakness, facial drooping, slurred speech, and severe global headache with no history of chronic illnesses. Non-contrast computed tomography of the brain revealed a hyperdense intracerebral haemorrhage, confirming stroke. An electrocardiogram revealed left ventricular and atrial enlargement, confirming cardiovascular manifestation. A transthoracic echocardiogram showed left ventricular hypertrophy and grade 1 diastolic dysfunction with an ejection fraction of 79%, suggestive of hypertensive heart disease. The persistently high blood pressure raised suspicion, and a 24-hour urine monitor for catecholamine and metanephrines was normal. Abdominal pelvic ultrasound showed a left adrenal mass. Adrenalectomy and biopsy were done, which confirmed pheochromocytoma. There was an improvement in the patient’s clinical status post-adrenalectomy. There are significant diagnostic challenges, including symptom overlap with other conditions, low clinical awareness, and the need for specific biochemical and imaging tests, which delay diagnosis and appropriate treatment. Early detection is essential to prevent life-threatening cardiovascular effects.