Ruptured hemorrhagic pheochromocytoma mimicking panic disorder: a case report

Abstract

Rare tumors that release catecholamines and originate in the adrenal medulla are called pheochromocytomas. They usually manifest as headaches, diaphoresis, palpitations, and hypertension, but occasionally they can resemble panic disorder. We report the case of a 51-year-old man who had dyspnea, chest pain, and a hypertensive crisis. Despite treatment with antihypertensives and anxiolytics, his symptoms persisted. Imaging revealed a large hemorrhagic adrenal mass consistent with a ruptured pheochromocytoma. Following laparoscopic adrenalectomy, histopathological analysis confirmed pheochromocytoma with a Zellballen pattern and vascular invasion but no capsular invasion. This case highlights the importance of considering secondary causes of hypertension, particularly pheochromocytoma, in patients with refractory symptoms and overlapping psychiatric features.