Khamal doghri sohaib

, university hospital ibn sina, Morocco
Title : Unusually case: a silent Pheochromocytoma revelated by thrombocytosis


Introduction: Pheochromocytoma is a tumor capable of producing catecholamines and a variety of biologically active neuropeptides. Usually manifested by high blood pressure. We report a case with rare expression, which is a reactive thrombocytosis produced by the pheochromocytoma.

Case report : 29-year-old patient admitted to the emergency on suspicion of colic, with low back pain, without other signs. physical examination finds arterial tension at 140/80 mmhg, FC : 80 bpm, abdominal sensitivity. abdominal ultrasound was normal, the biological analysis found a CRP at 300, VS at 61 mm/h, PNNs raised 2840 elm/ul, and thrombocytosis controled twice at 1 million/ul, ferritine at 310, CBEU: negative, thorax radio: normal, tumor markers: negatifs the patient was given an avlofloxacin for 7 days without improvement. The cervico thoraco abdominal scanner objectified a suspicious Surrenal mass of 2 cm, with irregular contours, heterogeneous, urinary methoxylen derivatives that returned to 5 times normal. The diagnosis of pheochromocytoma was retained. MIBG scan was negative as well as genetic study. 

Discussion : The unusual presentation of our pheochromocytoma case, with normal blood pressure, and a marked inflammatory response, indicates the complexity of the clinical manifestations of this tumor. There have been other reports of adrenal tumors presenting with fever, hypertension, anemia, thrombocytosis and hyperfibrinogenemia associated with higher levels of IL-6. Cytokine production by the tumor could play a crucial role in the emergence of unusual symptoms. His over-production can be either ascribed directly to the tumor or indirectly accounted for by tumoral production (high levels of norepinephrine).

 Conclusion : Pheochromocytoma may be a cause of paraneoplastic syndrome with pyrexia as well as inducing a marked increase in the levels of inflammatory markers. IL-6 appears as the primary mediator. This rare tumor is considered in the vast differential diagnosis of fever of unknown origin. 


Dr. Khamal doghri sohaib : Resident doctor since 2017 in the endocrinology department of the university hospital of Rabat, Morocco
-Former doctor of the Victor Jousselin hospital, Dreux, France (2018)
-Doctor of medicine since 2016
-Research doctor: participation in several international congresses, such: SMEDIAN 2018, SFE 2019, SFD 2020, ICE 2021, 2021, ENDO 2021, ECE 2021.