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Case Report
Bladder Pheochromocytoma Presented as Thunderclap Headache Triggered by Urination and Angina Pectoris - You Jin Han, Ho Sik Shin, Yeon Soon, Jung Hark Rim, So Young Ock, Eun Jeong Kim
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Kosin Medical Journal 2013;28(2):161-165.
DOI: https://doi.org/10.7180/kmj.2013.28.2.161
Published online: January 19, 2013
Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea
- Corresponding author: Ho Sik Shin, Department of Internal Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6108 FAX: +82-51-248-5686 E-mail: danieljoseph@hanmail.net
• Received: July 11, 2013 • Accepted: December 11, 2013
Copyright © 2013 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
- Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis, and angina pectoris. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by urination and angina pectoris as an initial manifestation. This case study suggests that thunderclap headache and angina pectoris occurring concurrently with sudden blood pressure elevation during or immediately after urination are important diagnostic clues of bladder pheochromocytoma.
Fig. 1.Abdominal CT showed an intraluminal polypoid mass of approximately 3 × 3.2 cm in size with heterogeneous enhancement at the left lateral wall of the urinary bladder.
Fig. 2.131I-MIBGs can showed partial uptake in the left side of the urinary bladder, which is consistent with pheochromocytoma.
Fig. 3.Macroscopically, the pheochromocytoma was a 3 × 3.2-cm sized mass abutting from the left wall of the urinary bladder.
Fig. 4.Immunohistochemical analysis revealed that the tumor cells were positive for chromogranin A staining (× 100).
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