Pheochromocytoma Diagnosed during the Treatment of Diffuse Alveolar Hemorrhage, a Diagnostic Necessity before Using High-dose Glucocorticoids

• Published in: Internal Medicine Vol. 60; no. 17; pp. 2825 - 2830
• Main Authors: Nezu, Masahiro, Kobayashi, Hiroaki, Shiozaki, Masashi, Katsumata, Miho, Takizawa, Soichi, Tsutsui, Toshiharu, Nukui, Ikuo, Miyashita, Yoshihiro, Oyama, Toshio, Inoue, Masaharu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.09.2021; Japan Science and Technology Agency
• Subjects: Alveoli; Case Report; catecholamine crisis; Catecholamines; diffuse alveolar hemorrhage; Dyspnea; Glucocorticoids; Hemoptysis; Hemorrhage; high-dose glucocorticoids; Hypertension; Internal medicine; Iodine; Paraganglioma; Pheochromocytoma; Respiration; Scintigraphy; pheochromocytoma; high-dose glucocorticoids; diffuse alveolar hemorrhage; catecholamine crisis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.6827-20

A 46-year-old woman with exacerbating hemoptysis and dyspnea was diagnosed with diffuse alveolar hemorrhage (DAH). High doses of glucocorticoids were initiated, but afterward, paroxysmal hypertension (210/140 mmHg) with headache and abdominal pain appeared. A 50-mm left adrenal tumor with an intense uptake by iodine-123 metaiodobenzylguanidine scintigraphy and catecholamine hypersecretion revealed complication with pheochromocytoma. Because high doses of glucocorticoids, sometimes required for DAH, can provoke life-threatening paroxysmal hypertension in pheochromocytoma and paraganglioma (PPGL), our case suggests that PPGL needs to be recognized as the cause of DAH and should be detected with whole-body imaging before starting glucocorticoids.