AUTHOR=Ziegler Christian G. , Riediger Carina , Gruber Matthias , Kunath Carola , Ullrich Martin , Pietzsch Jens , Nölting Svenja , Siepmann Timo , Bornstein Stefan R. , Remde Hanna , Constantinescu Georgiana 

TITLE=Case report: Incidentally discovered case of pheochromocytoma as a cause of long COVID-19 syndrome

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.967995

DOI=10.3389/fendo.2022.967995

ISSN=1664-2392

ABSTRACT=Pheochromocytomas (PCC) are rare but potentially lethal tumors that arise from the adrenal medulla. Clinical suspicion and diagnosis of PCC can be challenging due to the non-specific nature of signs and symptoms. In many patients infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could lead to long-term symptoms including fatigue, headaches, and cognitive dysfunction. Here, we present the case of a patient incidentally diagnosed with PCC after imaging was performed due to persisting complaints after COVID-19 infection. A 37-year-old male was referred to our center because of a right-sided inhomogenous adrenal mass, incidentally found during a computed tomographic scan of the thorax performed due to cough and dyspnea that persisted after COVID-19 infection. Other complaints included profuse sweating, dizziness, exhaustion with chronic fatigue and concentration difficulties. The patient had no history of hypertension, office blood pressure was normal and 24-hour ambulatory blood pressure monitoring confirmed normotension, but with absence of nocturnal dipping. Plasma normetanephrine was 5.7-fold above the upper limit (UL) of reference intervals (738 pg/ml, UL=129pg/ml), whereas plasma metanephrine and methoxytyramine were normal at 30pg/ml (UL=84pg/ml) and <4pg/ml (UL=16pg/ml), respectively. Preoperative preparation with phenoxybenzamine was initiated and a 4 cm tumor was surgically resected. Profuse sweating as well as the dizziness resolved after adrenalectomy pointing towards PCC and not COVID-19 associated patient concerns. Altogether, this case illustrates the difficulties in recognizing the possibility of PCC due to the non-specific nature of signs and symptoms of the tumor, which in this case did not include hypertension and coincided with some of the symptoms of long COVID-19.