Kosin Med J.  2013 Dec;28(2):161-165. 10.7180/kmj.2013.28.2.161.

Bladder Pheochromocytoma Presented as Thunderclap Headache Triggered by Urination and Angina Pectoris

• Han YJ
• Shin HS
• Jung YS
• Rim H
• Ock SY
• Kim EJ

• KMID: 1993575
• DOI: http://doi.org/10.7180/kmj.2013.28.2.161

Abstract

Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis, and angina pectoris. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by urination and angina pectoris as an initial manifestation. This case study suggests that thunderclap headache and angina pectoris occurring concurrently with sudden blood pressure elevation during or immediately after urination are important diagnostic clues of bladder pheochromocytoma.

Keyword

Angina pectoris; Pheochromocytoma; Thunderclap headache; Urination

MeSH Terms

Angina Pectoris*
Blood Pressure
Diagnosis
Female
Headache
Headache Disorders, Primary*
Humans
Hypertension
Neuroendocrine Tumors
Pheochromocytoma*
Strikes, Employee
Tachycardia
Urinary Bladder*
Urination*

Figure

• 

  Fig. 1. Abdominal CT showed an intraluminal polypoid mass of approximately 3 × 3.2 cm in size with heterogeneous enhancement at the left lateral wall of the urinary bladder.

• 

  Fig. 2. 131I-MIBGs can showed partial uptake in the left side of the urinary bladder, which is consistent with pheochromocytoma.

• 

  Fig. 3. Macroscopically, the pheochromocytoma was a 3 × 3.2-cm sized mass abutting from the left wall of the urinary bladder.

• 

  Fig. 4. Immunohistochemical analysis revealed that the tumor cells were positive for chromogranin A staining (× 100).

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