Case 9-2021: A 16-Year-Old Boy with Headache, Abdominal Pain, and Hypertension

This case report describes a 16 year old boy presenting with a 17 month history of worsening headaches, acute severe abdominal pain, and hypertensive emergency (BP 239/162 mm Hg). Initial symptoms were attributed to migraines and post traumatic headaches until lab results revealed leukocytosis, elevated troponin, and hyperglycemia. Imaging identified a heterogeneous right adrenal mass (7 cm) with hemorrhage, and biochemical testing confirmed markedly elevated plasma and urinary metanephrines (metanephrine: 16 nmol/L [normal <0.50]; normetanephrine: 52 nmol/L [normal <0.90]). The patient was stabilized with alpha blockade (phenoxybenzamine) and nicardipine, followed by surgical resection of the mass. Histopathology confirmed pheochromocytoma with a classic zellballen pattern and no malignant features. Postoperatively, blood pressure normalized without medications. The case underscores the importance of considering pheochromocytoma in pediatric patients with refractory hypertension and atypical headaches, highlighting the role of timely biochemical and imaging diagnostics.

This case report describes a 16 year old boy presenting with a 17 month history of worsening headaches, acute severe abdominal pain, and hypertensive emergency (BP 239/162 mm Hg). Initial symptoms were attributed to migraines and post traumatic headaches until lab results revealed leukocytosis, elevated troponin, and hyperglycemia. Imaging identified a heterogeneous right adrenal mass (7 cm) with hemorrhage, and biochemical testing confirmed markedly elevated plasma and urinary metanephrines (metanephrine: 16 nmol/L [normal <0.50]; normetanephrine: 52 nmol/L [normal <0.90]). The patient was stabilized with alpha blockade (phenoxybenzamine) and nicardipine, followed by surgical resection of the mass. Histopathology confirmed pheochromocytoma with a classic zellballen pattern and no malignant features. Postoperatively, blood pressure normalized without medications. The case underscores the importance of considering pheochromocytoma in pediatric patients with refractory hypertension and atypical headaches, highlighting the role of timely biochemical and imaging diagnostics.