Citation

Altiner S, Dodell G, Abed J, Blackford L, Colt E. Endocr. Pract. 2011; 17(5): e126-9.

Affiliation

Department of Internal Medicine, Columbia University School of Physicians and Surgeons, New York.

Copyright

(Copyright © 2011, American Association of Clinical Endocrinologists)

DOI

10.4158/EP10336.CR

PMID

21803721

Abstract

Objective: To document a case of pheochromocytoma with an unusually high plasma norepinephrine/epinephrine (NE/E) ratio, and a history of violent and aggressive behavior (which has been reported to be associated with increased NE/E ratios). Methods: We present the history of present illness, history of aggressive behavior, and the clinical course of a man who was found to have pheochromocytoma with a remarkable catecholamine profile. We also review the literature on relation of catecholamine ratios to behavior. Results: A 33-year old man presented to the emergency room with the chief complaint of palpitations and chest pain. Physical exam revealed markedly elevated blood pressure. CT scan of the abdomen on admission revealed a 10- by 10-cm heterogeneous mass of 20 Hounsfield units superior to the right kidney. Plasma NE/E ratio was 35 and 24-hour urine normetanephrine/metanephrine (NM/M) ratio was greater than 28. The tumor was successfully removed with laparoscopic adrenalectomy, and the biopsy revealed the diagnosis of benign pheochromocytoma. There was no immediate change in patient's behavior. The patient was incarcerated the week after surgery, and lost to follow-up. Conclusion: Primarily NE producing pheochromocytoma may have contributed to our patient's violent and aggressive behavior. Catecholamine levels may remain elevated for one week following surgery. Alternatively, even if our patient's NE level had dropped rapidly after removal of the pheochromocytoma, and it was not elevated a week later when he was arrested, it is possible that his aggressive behavior may have been conditioned by long exposure to elevated levels of NE.

Language: en