ABSTRACT
Phaeochromocytomas are rare neuroendocrine tumours, which can significantly increase the risk of cardiovascular morbidity and mortality. They are also recognised as 'the great mimic' and can present in many ways. A 42-year-old male patient presented with a non-ST elevation acute coronary syndrome and was medically treated pending an invasive coronary angiogram. During this procedure, he suffered a profound, symptomatic hypertensive surge documented with invasive pressure monitoring. This raised concern for potential secondary causes of hypertension, particularly given his age. He was subsequently diagnosed with a phaeochromocytoma, and after surgical resection of the tumour, his blood pressure control improved and he remains on single therapy only. As clinicians, it is important to remain alert for previously undiagnosed comorbidities contributing to common pathology, including rare, but life-threatening conditions as we present in this case.
Subject(s)
Acute Coronary Syndrome , Adrenal Gland Neoplasms , Hypertension , Pheochromocytoma , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/etiology , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/diagnostic imaging , Adult , Coronary Angiography , Humans , Hypertension/etiology , Male , Pheochromocytoma/diagnosis , Pheochromocytoma/diagnostic imagingABSTRACT
A 48-year-old man presented with a 2-month history of polyuria, polydypsia, chest pain, fever, cough and extreme weight loss. He was diagnosed with diabetic ketoacidosis and investigations revealed widespread infection with an empyema complicated by bronchopleural fistula, and iliopsoas, suprapubic and periarticular abscesses. Streptococcus milleri was cultured from all sites. A multidisciplinary medical and surgical approach was required for treatment. This case highlights the immunosuppression, and life-threatening complications arising from undiagnosed diabetes mellitus.