Abordagem de feocromocitoma no Sistema Único de Saúde: relato de caso

Abstract

Introduction: Pheochromocytoma is a rare neoplasm of the adrenal gland, secreting catecholamines, most common in the fourth or fifth decade of life. Early diagnosis is important as patients can develop serious illnesses in the long term. Systemic arterial hypertension, type 2 diabetes mellitus and seizures may be associated with the disease. Case report: Male, 56 years old, hypertensive, diabetic and diagnosed with epilepsy, referred to the outpatient clinic with pain in the right flank for 1 year and tumor in the right adrenal. He reported paroxysmal attacks (headache, palpitations and sweating), with frequent visits to the emergency room. Metanephrine dosage in 24-hour urine was greater than 5,000 pg/ml. Abdominal CT showed a solid lesion in the right adrenal, well-defined, low in fat (density of 41 HU), heterogeneous, measuring 10.4 x 9.9 x 9.3 cm, with an absolute “wash out” of less than 60%. After the diagnosis of Pheochromocytoma, he was admitted to hospital for alpha and beta blockade, followed by adrenalectomy. The surgery was performed uneventfully and the anatomopathological result was Pheochromocytoma. One month after surgery, the patient did not need antihypertensive or hypoglycemic drugs. Discussion: The diagnosis of rare diseases in the Brazilian population can be delayed due to difficulty in accessing medium and high complexity services in the SUS. The decision to hospitalize for preoperative preparation considered the patient's socioeconomic limitations. Untreated pheochromocytomas increase mortality from renal, cardiac, cerebral and vascular complications. Conclusion: Hospitalization was essential to provide better clinical and hemodynamic conditions for surgery. Surgical removal of Pheochromocytoma can lead to a cure for the disease, however, due to the risk of recurrence, long-term medical monitoring is recommended. The reported experience highlights the importance of the multidisciplinary team in decision making, individualizing each case.