Circulation. 2002;106:2143-2144
doi: 10.1161/01.CIR.0000037120.95689.D8
(Circulation. 2002;106:2143.)
© 2002 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Pheochromocytoma of the Urinary Bladder
Maxime Lamarre-Cliche, MD;
Anne Hernigou, MD;
Pierre Boutouyrie, MD, PhD;
Pierre-Francois Plouin, MD, PhD;
Michel Azizi, MD, PhD
From the Clinical Investigation Center 9201, Assistance-Publique des Hôpitaux de Paris/INSERM, and Departments of Hypertension, Radiology, and Pharmacology, Hôpital Européen Georges Pompidou, Paris, France.
Correspondence to Maxime Lamarre-Cliche, Institut de Recherches Cliniques de Montréal, Département de Recherche Clinique, 110 Ave des Pins, Montréal, Qc, H2W-1R7, Canada. E-mail lamarrm{at}ircm.qc.ca
A 37-year-old patient was referred to our hospital for probable pheochromocytoma of the urinary bladder. The patient had high blood pressure (BP) levels that increased after each micturition. The patient reported severe postmicturition headaches, palpitations, tinnitus, visual flashes, and symptoms of angina pectoris during the past 4 years. A right thalamic intracranial hemorrhage occurred 1 month before admittance. Basal urinary metanephrine excretion was extremely high (23.8 µmol/24 h; normal <3.7 µmol/24 h). As shown in Figure 1, micturition was associated with a major increase in BP and plasma norepinephrine concentrations. No adrenal or Zuckerkandl organ tumor was found on an abdom- inal computed tomography (CT) scan, but a right retrovesical mass was found on a pelvic CT scan (Figures 2 and 3). A single vesical mass appeared on I-131 meta-iodobenzylguanidine and octreotide nuclear scans. A partial cystectomy with tumor removal and right ureteral reimplantation was performed. Extensive vesical wall infiltration with cytonuclear abnormalities but normal lymph nodes was found on pathological examination. One month after surgery, urinary metanephrine levels were back to normal, seated blood pressure had decreased to 152/98 mm Hg, and the micturition-related adrenergic crises had disappeared.
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Figure 1. Perimicturition beat-to-beat hemodynamic monitoring and associated plasma norepinephrine concentrations showing an acute blood pressure increase with a concomitant norepinephrine release during micturition. Intravenous nicardipine had to be administered to decrease blood pressure and relieve symptoms.
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Figure 3. Three-dimensional reconstruction of bladder (green) and pheochromocytoma (red) from CT acquisition data.
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Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
