Clinical Analysis of Pheochromocytoma Misdiagnosed as Diabetes Mellitus and Stromal Tumor

LIU Jingwei; LIANG Junfeng; LI Mingxing; SONG Shiqiang

doi:10.3969/j.issn.1002-3429.2025.13.001

Abstract：Objective To analyze the clinical features,causes of misdiagnosis and preventive measures of pheochro-mocytoma.Methods The clinical data of 2 patients with pheochromocytoma misdiagnosed in our hospital from October 2020 to January 2024 were retrospectively analyzed.Results One patient presented with polyuria,excessive drinking,dry mouth,and fainting,with a history of renal calculi and constipation for many years,and was initially diagnosed with type 2 diabetes mellitus.At 7 d after the corresponding treatment,the patient suddenly had sweating,palpitations,headache,and paroxysmal hypertension.Abdominal ultrasound suggested a possible adrenal mass,and abdominal CT showed a circular soft tissue density shadow in the left adrenal gland,with uneven and delayed enhancement on the contrast-enhanced scan.Elevated levels of catecholamines were detected in the blood,confirming the diagnosis of adrenal pheochromocytoma,and the misdiagnosis lasted 1 year.After diagnosis,laparoscopic left adrenal pheochromocytoma resection was performed,and the diagnosis was confirmed by postoperative pathol-ogy.The patient was in good condition at 2-month follow-up.One patient presented with an upper abdominal mass during a phys-ical examination without obvious symptoms,was initially diagnosed as an abdominal stromal tumor and underwent laparoscopic exploration,which was converted to open exploration during the operation.When the tumor was dissected,the blood pressure in-creased rapidly.Ectopic pheochromocytoma was considered,and the surgery was terminated.Blood and urine catecholamine and metabolite levels were found to be elevated.Abdominal CT results confirmed the diagnosis of ectopic pheochromocytoma,and the patient underwent laparotomy under general anesthesia combined with retroperitoneal tumor resection and intestinal adhesiolysis.The diagnosis was confirmed by postoperative pathology,and the duration of misdiagnosis was 5 d.At 2-month follow-up,the patient was in good condition.Conclusions Pheochromocytoma has various clinical manifestations,and the misdiagnosis rate is high at initial diagnosis.Clinicians should attach great importance to this disease,inquiry about medical history carefully,make careful differential diagnosis,and promptly conduct detection of blood and urinary catecholamine hormone as well as abdominal CT examination as early as possible to improve the clinical diagnosis rate of this disease.