PAROXYSTIC HYPERTENSION IN A LONG-TERM HEMODIALYZED PATIENT - SUCCESSFUL ADRENALECTOMY FOR A DOPAMINE-PRODUCING PHEOCHROMOCYTOMA

Pheochromocytoma (Pheo) is an uncommon neoplasm producing blood pressu re troubles and it may be undiagnosed in chronic dialyzed patients in whom hypertension is a common finding. The symptoms in Pheo syndrome d epends on the prevalent catecholamine released, the most common being epinephrine (E) and norepinephrine (NE). Recently, a particular clinic al picture has been described for dopamine (DA)-producing Pheos, in wh om a normo-hypotensive status is more often observed. The authors repo rt a case of mainly dopamine-producing Pheo in a long-term dialyzed pa tient, successfully treated with adrenalectomy. The main steps in diag nosis and preoperative management are described and debated also in vi ew of the particular background produced by the end-stage renal failur e. The common imaging techniques adopted for adrenal medullary neoplas ms (US, CT, MIBG scintiscan) confirmed to be decisive for diagnosis; H PLC assay of plasma catecholamines is the only biochemical test availa ble in these patients although its significance is questionable due to the poor knowledge of catecholamine metabolism in chronic renal failu re. The clinical findings observed in this case seem in disagreement w ith those already reported in DA producing Pheos. Pheo in hemodialyzed patients is a rare event and it may be hidden by other more common ca uses of hypertension. However, more awareness from the medical staff a llows to diagnose the neoplasm correctly by the currently available me thods and to plan a safe surgical therapy also in high-risk patients.