CC: abdominal pain
ID: 57 year-old male with no past medical history presents with abdominal pain, right flank pain, dysuria and generalized symptoms of chills and fevers for 4 days. Interestingly, patient had exam findings consistent with neurofibromatosis type 1; skin exam was pertinent for neurofibromas, axillary freckling and >6 café au lait spots. He was admitted for work up and management of sepsis secondary to pyelonephritis as patient was also febrile and tachycardic with a neurophilic predominant leukocytosis. He began having intermittent episodes of hypertension overnight lasting 5 minutes with blood pressures as high as 220/150, raising suspicion for pheochromocytoma. Work up for pheochromocytoma returned back positive with serum total metanephrines 16,309 pg/mL, free metanephrine 9,944 pg/mL, free normetanephrine 6,442 pg/mL and a CT Abdomen that demonstrated a right adrenal mass measuring 7.8 x 7.5cm. After appropriate blood pressure control with alpha blockade followed by beta blockade, patient underwent surgical removal of the tumor with pathology confirming pheochromocytoma.
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