A RARE CAUSE FOR PALPITATIONS - BILATERAL PHEOCHROMOCYTOMA

Pheochromocytoma is a very rare neuroendocrine tumor during childhood, which originates from the chromaffin cells, mostly of the adrenals and sympathetic chain. According to literature its frequency is approximately 1 in 1,00,000 population. The classic clinical presentation includes paroxysmal attacks of headache, pallor, palpitations, and diaphoresis. However it can present with any sign and symptom due to catecholamine excess like hypertension, palpitation, headache, sweating, nausea, vomiting, tremors, irritation, epigastric pain, chest pain, dyspnoea, red warm face, numbness or paresthesia, blurred vision, dizziness, convulsion, tinnitus, dysarthria. These symptoms can be observed every day in severe disease. The clinical manifestation can be variable and resembling many other diseases, so the pheochromocytoma is called the Great imitator. Diagnosis can be made based on elevated levels of urinary catecholamines, but localization may require various modalities of investigations. Early diagnosis and treatment is important because the tumor may be fatal, if undiagnosed. We are presenting this case - a 10 years old girl, admitted with complaints of headache, palpitation and giddiness for 1 year, who on clinical examination was found to have hypertension. After a series of biochemical investigations and imaging studies, the diagnosis of bilateral pheochromocytoma was made. Child underwent surgery, bilateral adrenalectomy was done. The child is on regular follow up, remaining asymptomatic and normotensive till now. We present this case for its rarity. There had been only 23 cases of bilateral pheochromocytoma reported worldwide in children less than 10 years.