Phaeochromocytoma and Reversible Myocardial Ischaemia in a 23-year Old Female

Background : Phaeochromocytoma is a rare neuroendocrine tumour with highly variable clinical presentation including serious and potentially lethal cardiovascular complications. Aim: to present a case of myocardial ischaemia in Phaeochromocytoma which was reversed after surgery. Setting: University of Port Harcourt Teaching Hospital (UPTH). Case report: A young female undergraduate aged 23 years presented with recurrent blackouts; paroxysmal hypertension which was resistant to several anti- hypertensive drugs and marked postural drop was referred from a private clinic to UPTH. Rest electrocardiogram (ECG) showed ischaemic changes and right axis deviation. Ultrasound scan and compu- terised tomographic (CT) scan showed a mass on the anteromedial portion of the left kidney with centrally located cystic areas. The 24-hour urine level of vanillyl mandelic acid (VMA) was normal. The tumour was excised by open surgery and histopathological findings confirmed Phaeochromocytoma. The ECG changes reversed after surgical excision. There was no recurrence or metastasis postoperatively after a long term follow up of 5 years. Her blood pressure remained normal postoperatively without taking antihyperten- sive medication. Conclusion: Phaeochromocytoma is a catecholamine secreting neuroendocrine tumour with a high cardiovascular morbidity and mortality. ECG features of myo-cardial ischaemia can be reversed by surgical intervention

A 14-year-old Nigerian female with idiopathic intracranial hypertension (Pseudotumor cerebri or benign intracranial hypertension).

A 14-year-old secondary school girl presented with acute onset severe generalized headache associated with vomiting and diplopia. These followed an initial fever, which responded to chloroquine. She had been on peflacine for a left knee septic arthritis until onset of her symptoms. The main findings on physical examination were mild obesity, left abducent nerve palsy, bilateral papilledema and evidence of resolving arthritis of her left knee. The results of her investigations, including a brain CT scan were within normal limits. A diagnosis of IIH was made. She responded satisfactorily to oral acetazolamide with complete resolution of her symptoms and signs within 12 days of hospitalization and 2 weeks of follow-up.