Answer to Headache Study – Spring newsletter 2013

One evening after work he had started to feel unwell. He became hot, sweaty, tachycardic with headache and abdominal pain. His GP was called and thought he had an ‘acute abdomen’ and admitted him under the care of the on-call surgeons. His BP was 200/100. The surgeons were unsure as to what was happening and called in the on-call physician who, likewise, was uncertain. An urgent CT abdomen scan showed a unilateral adrenal mass. A phaeochromocytoma was then diagnosed clinically, removed successfully and confirmed histologically. He made an uncomplicated recovery. Think of phaeochromocytomas in paroxysmal headache with hypertension sweating and palpitations. Attacks may be provoked by movement, exercise, micturition or abdominal palpation. The high secretion of adrenaline and noradrenaline can produce a picture resembling cardiogenic shock. Clearly when “working upside down” he was compressing his phaeochromocytoma to cause excessive hormonal release which, in turn, produced his headaches.