An illustrative case: enough to raise one's blood pressure

A 64-year-old man was noted, during investigation of labile hypertension, to have marked central obesity and a plethoric facies. Tests revealed diabetes mellitus and consistently elevated urinary excretion of vanillylmandelic acid (VMA) at 1066, 661 and 500μmol/24 h (normal range 7–85). Imaging with meta-iodobenzylguanidine (MIBG) showed increased uptake in the region of the left adrenal gland (Fig. 1), and subsequent computed tomographic (CT) scans are illustrated in Fig. 2. A repeat CT scan 7 months following surgery is illustrated in Fig. 3. On the basis of the first CT scan, further investigations were undertaken. The biochemical findings together with the MIBG image are diagnostic of a phaeochromocytoma. The CT scan shows the presence of an 8 cm mass containing flecks of calcium, replacing the left adrenal gland, which confirms this diagnosis. In addition, there is marked hypertrophy of the right adrenal gland with preservation of its normal configuration, together with abundant retroperitoneal fat d...