ADRENAL MEDULLARY TUMOR (PHEOCHROMOCYTOMA); CASE REPORT WITH SUCCESSFUL OPERATION

Publisher Website
Google Scholar
Abstract
A case report of a 32 yr. old U. S. Army paratrooper seen June 11, 1943, in a U. S. Army Hospital in French Morocco with a duodenal ulcer and a pheochromocytoma of the left adrenal gland is presented. The presence of the tumor was suspected by the patient''s abnormal response to subcut. histamine phosphate given on a routine gastric analysis. The soldier''s blood pressure, which was normal on admission, rose to 260/160 5 min. after 1 ml. of histamine was administered subcut., and was accompanied by collapse, generalized pallor, intense sweating, dyspnea, and a severe headache. Subsequent paroxysmal episodes of hypertension were noted which led to the discovery of a tumor of the left adrenal gland, confirmed by peri-renal air insufflation. Electrocardiographs changes indicative of coronary vessel disturbances were noted 3 days after the use of the histamine test. Cold pressor tests failed to produce an abnormal rise in blood pressure, but an insulin tolerance test (4 units of regular insulin i.v.) produced a hypertensive reaction of the same degree seen with histamine. Histamine phosphate intradermally was noted to produce a hypertensive reaction. Doses of 0.01 mg., 0.02 mg., and 0.06 mg. given intradermally 5 min. and 11 1/2 min. after the first dose, respectively, were followed by symptoms of a hypertensive crisis in 15 min. and an elevation of blood pressure to 290 mm. of Hg in 22 min. The tumor was successfully removed. Subsequently, repeated insulin tolerance and histamine phosphate intradermally failed to reproduce a hypertensive crisis. Two mos. after operation, the patient was asymptomatic and his blood pressure was 95/65.