Adrenergic Storm with Obstructive Hydrocephalus
Atypical Neurological Presentation of Von Hippel-Lindau Disease with Bilateral Pheochromocytoma in an Adolescent
DOI:
https://doi.org/10.15605/jafes.040.02.18Keywords:
adolescent, germline mutation, obstructive hydrocephalus, Von Hippel-Lindau disease, pheochromocytoma, posterior reversible encephalopathy syndromeAbstract
Pheochromocytoma is often not the first diagnosis considered for many neurological complaints, especially obstructive hydrocephalus. We report a case of Von Hippel-Lindau disease in an adolescent presenting with obstructive hydrocephalus due to adrenergic storm requiring emergency ventriculoperitoneal shunt. This vignette emphasizes the importance of an integral approach, particularly accurate diagnosis that would lead to targeted pharmacological therapy focusing on alphaadrenergic receptor blockade, which was followed by total curative excision of pheochromocytoma in a timely fashion.
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References
1. Ciftci AO, Tanyel FC, Senocak ME, Büyükpamukçu N. Pheochromocytoma in children. J Pediatr Surg. 2001;36(3):447-52. https://pubmed.ncbi.nlm.nih.gov/11226993 https://doi.org/10.1053/jpsu.2001.21612
2. Aygun N, Uludag M. Pheochromocytoma and paraganglioma: From epidemiology to clinical findings. Sisli Etfal Hastan Tip Bul. 2020;54(2):159-68. https://pubmed.ncbi.nlm.nih.gov/32617052 https://pmc.ncbi.nlm.nih.gov/articles/PMC7326683 https://doi.org/10.14744/SEMB.2020.18794
3. Rupala K, Mittal V, Gupta R, Yadav R. Atypical presentation of pheochromocytoma: Central nervous system pseudovasculitis. Indian J Urol. 2017;33(1):82-4. https://pubmed.ncbi.nlm.nih.gov/28197038 https://pmc.ncbi.nlm.nih.gov/articles/PMC5264202 https://doi.org/10.4103/0970-1591.195760
4. Majic T, Aiyagari V. Cerebrovascular manifestations of pheochromocytoma and the implications of a missed diagnosis. Neurocrit Care. 2008;9(3):378-81. https://pubmed.ncbi.nlm.nih.gov/18509763 https://doi.org/10.1007/s12028-008-9105-8
5. Anderson NE, Chung K, Willoughby E, Croxson MS. Neurological manifestations of phaeochromocytomas and secretory paragangliomas: A reappraisal. J Neurol Neurosurg Psychiatry. 2013;84(4):452-7. https://pubmed.ncbi.nlm.nih.gov/23204473 https://doi.org/10.1136/jnnp-2012-303028
6. Ghorbani A, Reza Ostovan V. Atypical posterior reversible encephalopathy syndrome as the first presentation of a pheochromocytoma: A case report. Iran J Med Sci. 2020;45(6):485-90. https://pubmed.ncbi.nlm.nih.gov/33281266 https://pmc.ncbi.nlm.nih.gov/articles/PMC7707631 https://doi.org/10.30476/ijms.2020.85052.1486
7. Madhok J, Kloosterboer A, Venkatasubramanian C, Mihm FG. Catecholamine-induced cerebral vasospasm and multifocal infarctions in pheochromocytoma. Endocrinol Diabetes Metab Case Rep. 2020;2020:20-0078. https://pubmed.ncbi.nlm.nih.gov/32820130 https://pmc.ncbi.nlm.nih.gov/articles/PMC7487175 https://doi.org/10.1530/EDM-20-0078
8. Powell S, Kuhajda AI, Schlossman J, Bellizzi B. Posterior reversible encephalopathy syndrome as a presenting finding of multiple endocrine neoplasia type 2A Syndrome: A case report Neurology. 2025;104(7 Suppl 1):4593. https://doi.org/10.1212/WNL.0000000000211783.
9. Collao SF, Urbaneja IB, Librizzi MS, et al. Posterior reversible encephalopathy syndrome (PRES) as a presentation of a metastatic pheochromocytoma (PHEO). Endocrine Abstracts. 2023;90:EP616. https://doi.org/10.1530/endoabs.90.EP616
10. Kumar A, Keyrouz SG, Willie JT, Dhar R. Reversible obstructive hydrocephalus from hypertensive encephalopathy. Neurocrit Care. 2012;16(3):433-9. https://pubmed.ncbi.nlm.nih.gov/22234407 https://doi.org/10.1007/s12028-011-9663-z
11. Keyserling HF, Provenzale JM. Atypical imaging findings in a near-fatal case of posterior reversible encephalopathy syndrome in a child. AJR Am J Roentgenol. 2007;188(1):219-21. https://pubmed.ncbi.nlm.nih.gov/17179368 https://doi.org/10.2214/AJR.05.0328
12. Grossbach AJ, Abel TJ, Hodis B, Wassef SN, Greenlee JD. Hypertensive posterior reversible encephalopathy syndrome causing posterior fossa edema and hydrocephalus. J Clin Neurosci. 2014;21(2):207-11. https://pubmed.ncbi.nlm.nih.gov/24126039 https://doi.org/10.1016/j.jocn.2013.07.005
13. Ogino R, Yamamoto D, Furuya S, Teshigahara K, Kamiyama J. Acute obstructive hydrocephalus due to posterior reversible encephalopathy syndrome successfully treated with continuous ventricular drainage: a case report. Cureus. 2025;17(3):e80803. https://pubmed.ncbi.nlm.nih.gov/40255820 https://pmc.ncbi.nlm.nih.gov/articles/PMC12007928 https://doi.org/10.7759/cureus.80803
14. de Tersant M, Généré L, Freyçon C, et al. Pheochromocytoma and paraganglioma in children and adolescents: experience of the French Society of Pediatric Oncology (SFCE). J Endocr Soc. 2020;4(5):bvaa039. https://pubmed.ncbi.nlm.nih.gov/32432211 https://pmc.ncbi.nlm.nih.gov/articles/PMC7217277 https://doi.org/10.1210/jendso/bvaa039
15. Bholah R, Bunchman TE. Review of pediatric pheochromocytoma and paraganglioma. Front Pediatr. 2017;5:155. https://pubmed.ncbi.nlm.nih.gov/28752085 https://pmc.ncbi.nlm.nih.gov/articles/PMC5508015 https://doi.org/10.3389/fped.2017.00155
16. Bancos I, Bida JP, Tian D, et al. High-throughput screening for growth inhibitors using a yeast model of familial paraganglioma. PLoS One. 2013;8(2):e56827. https://pubmed.ncbi.nlm.nih.gov/ 23451094 https://pmc.ncbi.nlm.nih.gov/articles/PMC3579935 https://doi.org/10.1371/journal.pone.0056827.
17. Nolting S, Bechmann N, Taieb D, et al. Personalized management of pheochromocytoma and paraganglioma. Endocr Rev. 2022;43(2):199-239. https://pubmed.ncbi.nlm.nih.gov/34147030 https://pmc.ncbi.nlm.nih.gov/articles/PMC8905338 https://doi.org/10.1210/endrev/bnab019
18. Yamada T, Fukuoka H, Hosokawa Y, et al. Patients with pheochromocytoma exhibit low aldosterone renin ratio-preliminary reports. BMC Endocr Disord. 2020;20(1):140. https://pubmed.ncbi.nlm.nih.gov/32917197 https://pmc.ncbi.nlm.nih.gov/articles/PMC7488748 https://doi.org/10.1186/s12902-020-00620-6
19. Janssen I, Chen CC, Zhuang Z, et al. Functional imaging signature of patients presenting with polycythemia/paraganglioma syndromes. J Nucl Med. 2017;58(8):1236-42. https://pubmed.ncbi.nlm.nih.gov/28336782 https://pmc.ncbi.nlm.nih.gov/articles/PMC5537614 https://doi.org/10.2967/jnumed.116.187690
20. Taïeb D, Jha A, Treglia G, Pacak K. Molecular imaging and radionuclide therapy of pheochromocytoma and paraganglioma in the era of genomic characterization of disease subgroups. Endocr Relat Cancer. 2019;26(11):R627-52. https://pubmed.ncbi.nlm.nih.gov/31561209 https://pmc.ncbi.nlm.nih.gov/articles/PMC7002202 https://doi.org/10.1530/ERC-19-0165
21. Neumann HPH, Bausch B, McWhinney SR, et al; Freiburg-Warsaw-Columbus Pheochromocytoma Study Group. Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med. 2002;346(19):1459-66. https://pubmed.ncbi.nlm.nih.gov/12000816 https://doi.org/10.1056/NEJMoa020152
22. Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-42. https://pubmed.ncbi.nlm.nih.gov/24893135 https://doi.org/10.1210/jc.2014-1498
23. van Leeuwaarde RS, Ahmad S, van Nesselrooij B, Zandee W, Giles RH. Von Hippel-Lindau Syndrome. In: Adam MP, Feldman J, Mirzaa GM, et al, eds. GeneReviews®. Seattle, WA: University of Washington, Seattle; 2000. https://www.ncbi.nlm.nih.gov/books/NBK1463
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