2011 issue 1

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Volume 20, issue 1

Case report

Anxiety disorder and depression in the course of adrenal pheochromocytoma – a case report

Bertrand Janota1, Lucyna Papierska3, Maria Załuska2, Katarzyna Janota3, Andrzej Cichocki4, Elżbieta Piaseczyńska5
1. Oddział Psychiatrii, Szpital Bielański. Warszawa
2. IV Klinika Psychiatryczna, Instytut Psychiatrii i Neurologii, Warszawa
3. Klinika Endokrynologii i Oddział Chorób Wewnętrznych, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
4. Oddział Chirurgii, Klinika Instytutu Onkologii, Warszawa
5. Poradnia Zdrowia Psychicznego NZOZ, Biała Podlaska
Postępy Psychiatrii i Neurologii 2011, 20(1): 53–58
Keywords: pheochromocytoma / anxiety disorder / depression

Abstract

Background. The aim of the paper was to outline anxiety and depression symptoms and well as other somatic ailments in the course of pheochromocytoma of adrenal glands. This type of tumor is relatively rare, mostly benign, and hormonally active. Secreting excessive amounts of catecholamines the tumor may manifest itself in elevated blood pressure, tachycardia, nonspecific abdominal complaints, and sometimes symptoms of anxiety and depression. Early diagnosis and surgical removal of pheochromocytoma lead to full recovery in a majority of cases.
Case report. A female patient, not stressed and with no hypertension, had been unsuccessfully pharmacologically treated for anxiety and depression on the outpatient basis. Following an episode of acute abdominal pain and nausea her USG examination revealed a tumor in the right adrenal gland. Elevated urinary metoxycatecholamines suggested the diagnosis of pheochromocytoma, confirmed histopathologically. After surgical removal of the tumor and discontinuation of pharmacotherapy the patient's depressive and anxiety symptoms completely abated. No recurrence of the tumor was found within a 2-year follow-up period.
Commentary. Pheochromocytoma should always be taken into account in the differential diagnosis of anxiety and depression causes, since this condition if not recognized in time and left untreated may be fatal due to vascular complications and metastases. The reported case highlights the necessity of including pheochromocytoma in the differential diagnosis of anxiety and depressive disorders in the absence of hypertension, particularly if pharmacotherapy is ineffective and there are no significant stress factors. It should be remembered that signs and symptoms of pheochromocytoma include not only tachycardia, elevated blood pressure and headaches, but also abdominal complaints (pain, nausea, dyspepsia). The latter, interpreted as anxiety symptoms, may be actually manifestations of pheochromocytoma, and therefore require relevant screening procedures.

Address for correspondence:
Dr hab. n. med Maria Załuska
IV Klinika Psychiatrii IPIN w Szpitalu Bielańskim
01–809 Warszawa, ul. Cegłowska 80, tel/fax: 22 8644746
e-mail: ipin4kp@bielanski.med.pl; Od-psy2@bielanski.med.pl