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image of Sars-Cov-2 Infection as Catecholamin Crisis in Pheocreomocitoma: A Case Report

Abstract

Background

The primary presentation of SARS-CoV-2 infection is viral pneumonia, which may be complicated by acute respiratory distress syndrome, although several other manifestations can occur.. Endocrine implications have been described. Pheochromocytomas are rare tumors mainly originating in the adrenal medulla. Symptoms are primarily due to catecholamine overproduction and abrupt release. Catecholamine release is unregulated and could be continuous or paroxysmal. Some conditions (i.e., stress, physical exercise, or specific foods) can trigger catecholamine release. Sars-CoV-2 infections have not been previously described as precipitators of adrenergic crises in pheochromocytoma patients. In this study, we report a case of adrenal crisis of a patient affected by pheochromocytoma in the context of Sars-CoV-2 infection.

Case report

A 63-year-old Caucasian male known for right adrenal pheochromocytoma waiting for surgical removal was admitted to the Emergency Department (ED) in March 2021 for a fainting episode and hypertensive crisis that he never experienced before.

The patient had a known medical history of type 2 mellitus diabetes and hypercholesterolemia treated by slow-release metformin 500 mg/day and atorvastatin 40 mg/day and was not vaccinated for Sars-CoV-2. Two months before, the patient was hospitalized in another hospital for myocardial infarction with non-obstructive coronary arteries, and a chest-abdomen TC scan showed a right adrenal lodge occupied by coarse formation. In the 24-h urine sample, metanephrines were >5000 µg/24h and Normetanephrines >2500 µg/24h. Scintigraphy with 123I-Metaiodobenzylguanidine (MIBG) showed accumulation in right adrenal gland formation, confirming the suspicion of pheochromocytoma. No further areas of pathological uptake were present. Fort that, the patient was started on alpha-blockers (doxazosin 2 mg twice/day). Two weeks later, the patient was also prescribed metoprolol 50 mg twice/day.

When admitted to the Emergency Department (ED), Blood Pressure (BP) was 210/108 mmHg with a heart rate of 105 bpm. A routine nasopharyngeal swab for Sars-CoV-2 was performed, resulting positive. After an extra dosage of 2 mg of doxazosin and 20 mg of nifedipine, symptoms addressed to catecholamine release disappeared. Being positive for Sars-CoV-19, the patient was transferred to the infectious diseases department. High mean BP was demonstrated at the control profile. Doxazosin was increased to 4 mg twice a day with a good effect on BP and tachycardia. After 10 days, the SARS-CoV-2 swab result was negative, and the patient was discharged with normal vital parameters and instructions to continue the increased dose of doxazosin. No other crisis was reported until surgery, which was performed without any complications after 1 month.

Conclusion

Since the adrenal crisis is a life-threatening condition, we suggest close BP monitoring and therapeutic adherence in patients with pheochromocytoma waiting for surgery and living in areas characterized by outbreaks of COVID-19 infection. Moreover, we suggest considering an increase in alpha-blocker dosage to prevent the crisis.

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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2025-02-10
2025-05-09
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References

  1. Vetrugno G. Laurenti P. Franceschi F. Foti F. D'Ambrosio F. Cicconi M. Milia D. I.LA. Di Pumpo M. Carini E. Pascucci D. Boccia S. Pastorino R. Damiani G. De-Giorgio F. Oliva A. Nicolotti N. Cambieri A. Ghisellini R. Murri R. Sabatelli G. Musolino M. Gasbarrini A. Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): Preliminary results from a retrospective cohort study. Eur Rev Med Pharmacol Sci 2021 25 6 2785 2794 10.26355/eurrev_202103_25440 33829463
    [Google Scholar]
  2. Luigetti M. Iorio R. Bentivoglio A.R. Tricoli L. Riso V. Marotta J. Piano C. Primiano G. Zileri Del Verme L. Lo Monaco M.R. Calabresi P. Assessment of neurological manifestations in hospitalized patients with COVID‐19. Eur. J. Neurol. 2020 27 11 2322 2328 10.1111/ene.14444 32681611
    [Google Scholar]
  3. Ianiro G. Porcari S. Settanni C.R. Bibbò S. Ponziani F.R. Zileri dal Verme L. Franceschi F. Cammarota G. Gasbarrini A. Letter: Prevalence and patterns of gastrointestinal symptoms in a large Western cohort of patients with COVID‐19. Aliment. Pharmacol. Ther. 2020 52 5 902 903 10.1111/apt.15946 32852826
    [Google Scholar]
  4. Ojetti V. Saviano A. Covino M. Acampora N. Troiani E. Franceschi F. Abbate V. Acampora N. Addolorato G. Agostini F. Ainora M.E. Akacha K. Amato E. Andreani F. Andriollo G. Annetta M.G. Annicchiarico B.E. Antonelli M. Antonucci G. Anzellotti G.M. Armuzzi A. Baldi F. Barattucci I. Barillaro C. Barone F. Bellantone R.D.A. Bellieni A. Bello G. Benicchi A. Benvenuto F. Berardini L. Berloco F. Bernabei R. Bianchi A. Biasucci D.G. Biasucci L.M. Bibbò S. Bini A. Bisanti A. Biscetti F. Bocci M.G. Bonadia N. Bongiovanni F. Borghetti A. Bosco G. Bosello S. Bove V. Bramato G. Brandi V. Bruni T. Bruno C. Bruno D. Bungaro M.C. Buonomo A. Burzo L. Calabrese A. Calvello M.R. Cambieri A. Cambise C. Cammà G. Candelli M. Canistro G. Cantanale A. Capalbo G. Capaldi L. Capone E. Capristo E. Carbone L. Cardone S. Carelli S. Carfì A. Carnicelli A. Caruso C. Casciaro F.A. Catalano L. Cauda R. Cecchini A.L. Cerrito L. Cesarano M. Chiarito A. Cianci R. Cicchinelli S. Ciccullo A. Cicetti M. Ciciarello F. Cingolani A. Cipriani M.C. Consalvo M.L. Coppola G. Corbo G.M. Corsello A. Costante F. Costanzi M. Covino M. Crupi D. Cutuli S.L. D’Addio S. D’Alessandro A. D’AlfonsoD’Angelo M.E.E. D’Aversa F. Damiano F. De Berardinis G.M. De Cunzo T. De Gaetano D.K. De Luca G. De Matteis G. De Pascale G. De Santis P. De Siena M. De Vito F. Del Gatto V. Del Giacomo P. Del Zompo F. Dell’Anna A.M. Polla D.D. Di Gialleonardo L. Di Giambenedetto S. Di Luca R. Di Maurizio L. Di Muro M. Dusina A. Eleuteri D. Esperide A. Fachechi D. Faliero D. Falsiroli C. Fantoni M. Fedele A. Feliciani D. Ferrante C. Ferrone G. Festa R. Fiore M.C. Flex A. Forte E. Franceschi F. Francesconi A. Franza L. Funaro B. Fuorlo M. Fusco D. Gabrielli M. Gaetani E. Galletta C. Gallo A. Gambassi G. Garcovich M. Gasbarrini A. Gasparrini I. Gelli S. Giampietro A. Gigante L. Giuliano G. Giuliano G. Giupponi B. Gremese E. Grieco D.L. Guerrera M. Guglielmi V. Guidone C. Gullì A. Iaconelli A. Iafrati A. Ianiro G. Iaquinta A. Impagnatiello M. Inchingolo R. Intini E. Iorio R. Izzi I.M. Jovanovic T. Kadhim C. La Macchia R. La Milia D.I. Landi F. Landi G. Landi R. Landolfi R. Leo M. Leone P.M. Levantesi L. Liguori A. Liperoti R. Lizzio M.M. Monaco M.R.L. Locantore P. Lombardi F. Lombardi G. Lopetuso L. Loria V. Losito A.R. Lucia M.B.P. Macagno F. Macerola N. Maggi G. Maiuro G. Mancarella F. Mangiola F. Manno A. Marchesini D. Maresca G.M. Marrone G. Martis I. Martone A.M. Marzetti E. Mattana C. Matteo M.V. Maviglia R. Mazzarella A. Memoli C. Miele L. Migneco A. Mignini I. Milani A. Milardi D. Montalto M. Montemurro G. Monti F. Montini L. Morena T.C. Morra V. Morretta C. Moschese D. Murace C.A. Murdolo M. Murri R. Napoli M. Nardella E. Natalello G. Natalini D. Navarra S.M. Nesci A. Nicoletti A. Nicoletti R. Nicoletti T.F. Nicolò R. Nicolotti N. Nista E.C. Nuzzo E. Oggiano M. Ojetti V. Pagano F.C. Paiano G. Pais C. Pallavicini F. Palombo A. Paolillo F. Papa A. Papanice D. Papparella L.G. Paratore M. Parrinello G. Pasciuto G. Pasculli P. Pecorini G. Perniola S. Pero E. Petricca L. Petrucci M. Picarelli C. Piccioni A. Piccolo A. Piervincenzi E. Pignataro G. Pignataro R. Pintaudi G. Pisapia L. Pizzoferrato M. Pizzolante F. Pola R. Policola C. Pompili M. Pontecorvi F. Pontecorvi V. Ponziani F. Popolla V. Porceddu E. Porfidia A. Porro L.M. Potenza A. Pozzana F. Privitera G. Pugliese D. Pulcini G. Racco S. Raffaelli F. Ramunno V. Rapaccini G.L. Richeldi L. Rinninella E. Rocchi S. Romanò B. Romano S. Rosa F. Rossi L. Rossi R. Rossini E. Rota E. Rovedi F. Rubino C. Rumi G. Russo A. Sabia L. Salerno A. Salini S. Salvatore L. Samori D. Sandroni C. Sanguinetti M. Santarelli L. Santini P. Santolamazza D. Santoliquido A. Santopaolo F. Santoro M.C. Sardeo F. Sarnari C. Saviano A. Saviano L. Scaldaferri F. Scarascia R. Schepis T. Schiavello F. Scoppettuolo G. Sedda D. Sessa F. Sestito L. Settanni C. Siciliano M. Siciliano V. Sicuranza R. Simeoni B. Simonetti J. Smargiassi A. Soave P.M. Sonnino C. Staiti D. Stella C. Stella L. Stival E. Taddei E. Talerico R. Tamburello E. Tamburrini E. Tanzarella E.S. Tarascio E. Tarli C. Tersali A. Tilli P. Timpano J. Torelli E. Torrini F. Tosato M. Tosoni A. Tricoli L. Tritto M. Tumbarello M. Tummolo A.M. Vallecoccia M.S. Valletta F. Varone F. Vassalli F. Ventura G. Verardi L. Vetrone L. Vetrugno G. Visconti E. Visconti F. Viviani A. Zaccaria R. Zaccone C. Zelano L. Dal Verme L.Z. Zuccalà G. COVID-19 and intestinal inflammation: Role of fecal calprotectin. Dig. Liver Dis. 2020 52 11 1231 1233 10.1016/j.dld.2020.09.015 33060042
    [Google Scholar]
  5. Pal R. Banerjee M. COVID-19 and the endocrine system: exploring the unexplored. J. Endocrinol. Invest. 2020 43 7 1027 1031 10.1007/s40618‑020‑01276‑8
    [Google Scholar]
  6. Chang L. Yan Y. Wang L. Coronavirus disease 2019: Coronaviruses and blood safety. Transfus. Med. Rev. 2020 34 2 75 80 10.1016/j.tmrv.2020.02.003 32107119
    [Google Scholar]
  7. Farrugia F.A. Charalampopoulos A. Pheochromocytoma. Endocr. Regul. 2019 53 3 191 212 10.2478/enr‑2019‑0020 31517632
    [Google Scholar]
  8. Riley D.S. Barber M.S. Kienle G.S. Aronson J.K. von Schoen-Angerer T. Tugwell P. Kiene H. Helfand M. Altman D.G. Sox H. Werthmann P.G. Moher D. Rison R.A. Shamseer L. Koch C.A. Sun G.H. Hanaway P. Sudak N.L. Kaszkin-Bettag M. Carpenter J.E. Gagnier J.J. CARE guidelines for case reports: Explanation and elaboration document. J. Clin. Epidemiol. 2017 89 218 235 10.1016/j.jclinepi.2017.04.026 28529185
    [Google Scholar]
  9. Casey R.T. Valk G.D. Schalin-Jäntti C. Grossman A.B. Thakker R.V. Clinical management of neuroendocrine neoplasms (NENs). Eur. J. Endocrinol. 2020 183 2 G79 G88 10.1530/EJE‑20‑0424 32554825
    [Google Scholar]
  10. Myers M.G. Arshinoff S.A. Infection and Pheochromocytoma. JAMA 1977 237 19 2095 2096 10.1001/jama.1977.03270460081028 576892
    [Google Scholar]
  11. Broadfoot B.G. Kumarapeli A.R. Pheochromocytoma multisystem crisis and masquerading disseminated histoplasmosis in a neurofibromatosis type 1 patient with bilateral adrenal tumors. Acad. Forensic Pathol. 2020 10 1 62 68 10.1177/1925362120947621 32983295
    [Google Scholar]
  12. Gubbi S. Nazari M.A. Taieb D. Klubo-Gwiezdzinska J. Pacak K. Catecholamine physiology and its implications in patients with COVID-19. Lancet Diabetes Endocrinol. 2020 8 12 978 986 10.1016/S2213‑8587(20)30342‑9 33128872
    [Google Scholar]
  13. Eisenhofer G. Rivers G. Rosas A.L. Quezado Z. Manger W.M. Pacak K. Adverse drug reactions in patients with phaeochromocytoma: incidence, prevention and management. Drug Saf. 2007 30 11 1031 1062 10.2165/00002018‑200730110‑00004 17973541
    [Google Scholar]
  14. Rebollo-Román A. Alhambra-Expósito M.R. Herrera-Martínez Y. Leiva-Cepas F. Alzas C. Muñoz-Jiménez C. Ortega-Salas R. Molina-Puertas M.J. Gálvez-Moreno M.A. Herrera-Martínez A.D. Catecholaminergic crisis after a bleeding complication of COVID-19 infection: A case report. Front. Endocrinol. (Lausanne) 2021 12 693004 10.3389/fendo.2021.693004 34566886
    [Google Scholar]
  15. Rojbi I. Adel M. Affes M. Hantous S. Jrad M. Ben Nacef I. Khiari K. Pheochromocytoma presenting as fulminant myocarditis mimicking COVID‐19 pneumonia. Clin. Case Rep. 2021 9 11 e05046 10.1002/ccr3.5046 34765217
    [Google Scholar]
  16. Mayer F. III Memon R. Stowens J. Diagnosing pheochromocytoma in the COVID-19 era: A case report. Clin. Pract. Cases Emerg. Med. 2022 6 3 220 224 10.5811/cpcem.2022.2.55091 36049208
    [Google Scholar]
  17. Lai E.W. Perera S.M. Havekes B. Timmers H.J.L.M. Brouwers F.M. McElroy B. Adams K.T. Ohta S. Wesley R.A. Eisenhofer G. Pacak K. Gender-related differences in the clinical presentation of malignant and benign pheochromocytoma. Endocrine 2008 34 1-3 96 100 10.1007/s12020‑008‑9108‑4 18982461
    [Google Scholar]
  18. Casey R.T. Valk G.D. Schalin-Jäntti C. Grossman A.B. Thakker R.V. Endocrinology in the time of COVID-19: Clinical management of neuroendocrine neoplasms (NENs). Eur. J. Endocrinol. 2020 183 2 G79 G88 10.1530/EJE‑20‑0424 32554825
    [Google Scholar]
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  • Article Type:
    Case Report
Keywords: adrenal gland ; adrenal crisis ; covid-19 ; Pheochromocytoma
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