Recurrent Pheochromocytoma with Recognition of Site of Metastasis by Means of Venous Catheterization

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Abstract
A twenty year-old female developed recurrence of hypertension eight years after a pheochromocytoma had been removed from the right adrenal area. Initially studies of the cause of the recurrent hypertension were equivocal, but eventually the presence of pheochromocytoma was again established. Venous catheterization with measurement of plasma catecholamines from multiple sites suggested that the recurrent tumor was located in the thorax. Thoracotomy confirmed this prediction. Previous experience by others suggests that this means of tumor localization may be helpful in those instances in which the hormone secreted is norepinephrine, or in which malignancy is suspected for any reason. An incidental finding of interest in this case was the development of deep, symmetrical T-wave inversions in the electrocardiogram; the possibility of catecholamine effects on the myocardium has been suggested. Another finding of interest was a lowering of VMA excretion and blood pressure during the administration of alpha-methyldopa, an inhibitor of norepinephrine biosynthesis.