Hypertension Secondary to a Pheochromocytoma in the Context of a Multiple Adrenal Tumor: A Case Report

Pheochromocytoma is a rare but curable cause of hypertension. When it is not discovered incidentally during a morphological examination, it can cause variable, fluctuating, nonspecific clinical manifestations, and sometimes even no symptoms at all. We report the case of a 42-year-old man who was being treated for uncontrolled hypertension with dual therapy; investigation of an adrenal incidentaloma, discovered during a workup for hypertension, led to the diagnosis of an isolated right adrenal pheochromocytoma. The patient underwent laparoscopic adrenalectomy, with a postoperative course marked by normalization of blood pressure and the subsequent development of adrenocortical insufficiency. Pathological examination confirmed the pheochromocytoma, with loss of fumarate hydratase expression and multiple adjacent adrenocortical nodules secreting cortisol and aldosterone. Our case illustrates the need to consider a secondary cause when evaluating hypertension in a young patient or in cases of de novo hypertension, the value of abdominal imaging in the workup, the complexity of mixed secretions (catecholamines and cortisol), and the importance of postoperative endocrine follow-up for the early detection of adrenal insufficiency. Finally, the discovery of fumarate hydratase (FH) deficiency requires genetic evaluation and personalized follow-up.