case report
Panic attacks and palpitations pointed to psychiatry. A pheochromocytoma did not.
2026-06-23
Panic attacks and palpitations pointed to psychiatry. A pheochromocytoma did not.
Six months of episodes
A 16-year-old boy in Trinidad and Tobago began experiencing a cycle of physical distress. For six months, he suffered from episodic headaches, drenching sweats (diaphoresis), and palpitations. During these episodes, his vision would become blurry, and his heart would race.
These symptoms—paroxysmal spikes in heart rate and drenching sweats—are the classic hallmarks of a body flooded by catecholamines. Often mistaken for panic attacks or severe anxiety in young patients, the symptoms in this case were accompanied by significantly elevated blood pressure. He had no palpable masses in his neck or abdomen, and an eye examination was initially normal.
The hypertensive emergency
The situation escalated when the teenager was admitted to a medical ward for a hypertensive emergency. His blood pressure reached 225/120 mmHg. During this admission, he was managed with intravenous medications that provided only partial relief.
Tests revealed another layer to his clinical picture: he was diabetic, with an HbA1c of 8.9%. He was started on metformin, but the underlying cause of both his soaring blood pressure and his new-onset metabolic issues remained to be identified. He was referred to an endocrinologist for a deeper workup.
The chemical signature
Broad laboratory investigations for renal, liver, and thyroid function all came back within normal ranges. However, specialized testing of his serum catecholamines revealed the source of his "anxiety" and hypertension. His norepinephrine level was 2279 pg/mL, nearly three times the upper limit of normal. His normetanephrine level was 2233.8 pg/mL, more than fourteen times the reference value of 150 pg/mL.
A contrast CT scan of the abdomen and pelvis followed. It revealed a 4.2cm x 3.4cm x 4.8cm mass on his right adrenal gland. The diagnosis was now clear: a functional right pheochromocytoma, a rare tumor of the chromaffin cells that acts like a faulty faucet, leaking adrenaline-like chemicals into the bloodstream.
Surgical resolution
Before surgery could be performed, the patient required careful stabilization to prevent a "catecholamine storm." He was treated with the alpha antagonist terazosin to control his blood pressure and placed on a high-sodium diet to expand his blood volume. Because his heart rate remained stable, beta blockers were not required.
Surgeons performed a laparoscopic adrenalectomy, a complex procedure in an adolescent. They used a "non-handling" technique of the adrenal gland to prevent the accidental release of more hormones during the operation. The 6 cm right adrenal gland was successfully removed through an endoscopic retrieval bag.
A full recovery
The results were immediate. By the first day after surgery, the boy was weaned off vasopressors. He was discharged from the hospital on the second day with satisfactory blood pressure readings, no longer requiring any antihypertensive medications.
Fifteen months later, the physical symptoms of his six-month ordeal have not returned. His blood pressure logs remain within normal limits, and remarkably, his diabetes has resolved; his HbA1c returned to a normal value of 5.2% without the need for further treatment. The "panic" and the physiological crisis were gone.
The medical picture
Serum Norepinephrine
2279 pg/mL (Reference: 0-874 pg/mL)
Serum Normetanephrine
2233.8 pg/mL (Reference: 0-150.8 pg/mL)
HbA1c
8.9%
Blood Pressure (Peak)
225/120 mmHg
Adrenal Mass Size (CT)
4.2cm x 3.4cm x 4.8cm
Adapted faithfully from the open-access case report: Cureus (PMC12286708). DOI: 10.7759/cureus.86623. Read the original at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286708/.