A case report of reactive hypoglycemia in a patient with pheochromocytoma and it's review of literature
A 51-year-old female initially presented to the Department of Surgery with complaint of recurrent nonbilious vomiting. USG abdomen revealed cholelithiasisand a right adrenal mass. Patient denied complaints of episodic palpitations, headache, sweating or weight loss. There was no history of early satiety or constipation. There was a history of frequent intake of meals at an interval of 3-4 hrs. She denied any history suggestive of postprandial hypoglycemia. She was diagnosed to be hypertensive around 3 years back, but she was not taking regular medication. She had been taking tablet Amlodipine 10 mg and Olmesartan 40 mg and referred to the Endocrine Unit. There was no family history suggestive of Hypertension, DM, CAD or MEN.\nExamination revealed a thin built female of height 5′3″, weight 43 kg, BMI: 16.79 Kg/m2. Blood pressure was 115/80 mmHg in supine position and 104/80 mmHg in standing position. There was no postural drop in blood pressure. Systemic examination was unremarkable. Biochemical investigations revealed normal hemogram, liver function test and kidney function test. The 24-hour urine catecholamines were elevated [VMA: 36.63 mg/g creatinine (1.6-4.2 mg/g), Epinephrine: 81.42 pg/ml (<67 pg/ml), Norepinephrine: 876.47 ng/ml (95-446 ng/ml), Dopamine: 51.61 pg/ml]. Postprandial glucose levels were reported as 30 mg/dL and 54 mg/dL on two different occasions. An extended oral glucose tolerance test was done which showed reactive hypoglycemia and hyperinsulinemia at 3 hrs []. HbA1C was 6.20%. Thyroid function test and serum cortisol levels were normal. CT abdomen and pelvis showed partially necrotic, otherwise well defined mass in the right adrenal measuring 42 × 39 mm in size. An incidental finding of mural thickening of antrum of stomach was found. Echocardiography revealed severe concentric Left ventricular hypertrophy, mild MR, AR and LV diastolic dysfunction with left ventricular ejection fraction of 60%.\nPatient underwent surgery after appropriate hypertensive management with α and β-blockers. Histopathology revealed tumor cells with abundant amphophilic granular cytoplasm, vesicular nuclei and few cells showed nucleoli with occasional mitotic figures suggestive of pheochromocytoma [].