The Importance of Exclusion of Obstructive Sleep Apnea During Screening for Adrenal Adenoma and Diagnosis of Pheochromocytoma.

摘要: Context. As catecholamine elevation is a key element in the diagnosis of pheochromocytoma, more commonplace causes sympathetic excess, such as obstructive sleep apnea (OSA), should be excluded standard practice prior to diagnosis. This essential avoid misdiagnosis adrenal incidentalomas identified estimated 42 million Americans with OSA, greater than 4 projected undergo computed tomography study annually. Case Description. A 56-year-old woman presented several year history paroxysmal hypertension, palpitations, and diaphoresis. Abdominal/pelvic performed during an unrelated hospitalization revealed 2-cm left-sided nodule initially quantified at 37 Hounsfield units. Posthospitalization, 24-hour urine normetanephrine level was markedly elevated. Reassessment 2 weeks later continued excess. Following normal thyroid function tests, morning cortisol, aldosterone, plasma renin activity, laparoscopic adrenalectomy performed. Surgical pathology cortical adenoma. paroxysms postoperatively, repeat metanephrines were measured, demonstrating essentially unchanged elevation. Search for alternate cause ensued, revealing OSA progressive continuous positive airway pressure noncompliance over preceding year. Regular therapy resumed, end 7 weeks, levels had declined. Conclusion. Pheochromocytomas are rare common. However, overlap clinical symptoms between these disorders substantial, their ability produce Thus, excluding uncontrolled or undiagnosed high-risk patients before diagnosing pheochromocytoma.