# Pheochromocytoma in a Patient With Chronic Hypotension: A Case Report

## TL;DR

A patient with chronic low blood pressure and heart palpitations was diagnosed with a rare adrenal tumor called pheochromocytoma and successfully treated with surgery.

## Contribution

This case report highlights the unusual presentation of pheochromocytoma with chronic hypotension rather than typical hypertension.

## Key findings

- The patient had a peripherally located adrenal tumor confirmed by elevated normetanephrines.
- Surgical resection resolved the patient's symptoms with no evidence of disease recurrence.
- The case demonstrates that pheochromocytoma can present with atypical symptoms like chronic hypotension.

## Abstract

Pheochromocytomas are neuroendocrine tumors that commonly present with hypertension, headache, palpitations, perspiration, and facial flushing. The diagnosis is typically made with imaging demonstrating an adrenal mass and elevated metanephrines and normetanephrines. The recommended treatment is medical optimization and adrenalectomy. Here, we present the case of a patient referred to our surgical oncology clinic with diagnostic challenges due to chronic hypotension and only heart palpitations. She was found to have a peripherally located adrenal mass extending over the renal hilum with an otherwise normal adrenal gland. Elevated plasma and urine normetanephrines were found, so the patient underwent complete resection of the tumor with en bloc adrenalectomy and was ultimately found to have a pheochromocytoma.  After surgery, she has no evidence of disease and has had resolution of palpitations.