A case of normotensive pheochromocytoma with management dilemma.

[adrenal incidentaloma]

We report an unusual case of normotensive pheochromocytoma detected incidentally , presenting a pre-operative management problem .A 40 -year -old lady with vague abdominal symptoms was initially discovered with a left adrenal incidentaloma by ultrasound abdomen , which was also revealed in computed tomography (CT ). After exclusion of all the causes with possible necessary investigations , pheochromocytoma was confirmed with elevated 24 hour urinary metanephrine and normetanephrine . Her blood pressure was in low to normotensive range all throughout . She was attempted to be prepared with combined alpha and beta blockade but could not tolerate this regimen due to symptomatic hypotension . Subsequently , surgical preparation was planned cautiously with alpha-adenergic blockade only . With intensive monitoring , she underwent uneventful left adrenalectomy , and surgical pathology was consistent with pheochromocytoma .This case illustrates an unusual presentation of normotensive pheochromocytoma as adrenal incidentaloma . Pre-operative preparation in these patients can be achieved with alpha-adrenergic blockade , adequate hydration , and liberal salt intake .