A case of diabetes with unexpected outcome! Sergio Cappello, Armando Giancola, Luigi Iamele, Maria Pipino, Graziano Minafra, Mattea Carbone, Luigi Caccetta,

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A case of diabetes with unexpected outcome! Sergio Cappello, Armando Giancola, Luigi Iamele, Maria Pipino, Graziano Minafra, Mattea Carbone, Luigi Caccetta, Maria Insalata, Sara D’Arnese, Cesar Garcia, Francesco Ventrella S.C. Medicina Interna, Ospedale “G. Tatarella”, Cerignola – ASL FG (direttore dott. Francesco Ventrella) A male patient of 40 years is hopitalized for weight loss of 20 kg in 3 months and early detection of high blood glucose with moderate increase of the blood pressure. About 3 weeks before, he had been admitted to another hospital and discharged with diagnosis of diabetes mellitus and prescription of metformin. First level diagnostics ECG : signs of left ventricular hypertrophy Ecocardiography: moderate concentric left ventricular hypertrophy Gastroscopy: normal. Doppler ultrasound of the vessels of the neck: normal Thyroid ultrasound : nodular thyroid desease. Abdominal ultrasound: mild hepatic steatosis, adenomyomas gallbladder, and a 7 cm tumor of the adrenal left ; regular kidney arterial vascularization. References Pheochromocytoma presenting as diabetic ketoacidosis. J Diabetes Complications Jul-Aug;22(4):295-6J Diabetes Complications. A pheochromocytoma presenting with hyperglycemia. Indiana Med Dec;78(12): Indiana Med. Phaeochromocytoma with hyperglycaemia and hyperinsulinaemia. Clin Endocrinol (Oxf) Jul;21(1):89-90.Clin Endocrinol (Oxf). Clinical spectrum of pheochromocytoma. J Am Coll Surg Dec;209(6):727-32J Am Coll Surg. Pheochromocytoma - update on disease management. Ther Adv Endocrinol Metab Feb;3(1):11-26Ther Adv Endocrinol Metab. Subclinical phaeochromocytoma. Best Pract Res Clin Endocrinol Metab Aug;26(4):507-15Best Pract Res Clin Endocrinol Metab. Congresso Nazionale FADOI : Torino 9-12 maggio 2015 The patient underwent excision of the left adrenal gland that confirmed the diagnosis of benign pheochromocytoma, and corrected both problems [hypertension and diabetes]. Second level diagnostics CEUS : rapid and uniform enhancement with clear evidence of the afferent artery, but lower than ipsilateral kidney and the spleen. Total body TC with cm: confirmed the large tumor with centripetal enhancement and the presence of peripheral angiogenesis, no cleavage plane with the diaphragm, compression of the superior pole of the ipsilateral kidney. 123 I-MIBG Total body scintigraphy: intense accumulation of radio-marker in a round mass in the left adrenal lodge The laboratory Plasma renin activity and aldosterone were normal but the patients was taking ace inhibitors. Insulin antibodies were normal HB1c 10.4 %, C-peptide 2.5, glycemia 174 mg⁄dl Marked increase: plasma norepinephrine [x 25] plasma adenaline [x 19] 24 hours urine metanephrine [x 23] 24 hours urine normetanephrine [x 13] 24 hours urine vanillylmandelic acid [x 5] 24 hours urine adrenaline [x 15] 24 hours urine noradrenaline [x 5] The originality of this case lies in the very few reports in the literature about this mode of presentation: mild hypertension without crisis, and diabetes.