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Case of Chronic Indolent Pheochromocytoma That Caused Medically Controlled Hypertension but Treatment-Resistant Diabetes Mellitus.

A 47-year-old woman visited the emergency room in March 2006. Her main complaint was dyspnea, which began 2 months before. She was a previously healthy woman, but after upper respiratory infection 2 months before, she developed symptoms of cough, myalgia, epigastric pain, and dyspnea of New York Heart Association functional class II to III with intermittent chilling. She was managed at the local clinic for asthma, but there was no improvement in symptoms.

One month before the emergency room visit, she had a procedure for anal hemorrhoids and bled severely and received transfusion. Three days before visiting the emergency room, cough and dyspnea deteriorated. She went to the local hospital, was diagnosed with heart failure, and was referred to the emergency room. There was nothing notable in her medical history. She was a housewife, nonsmoker, and did not drink alcohol. She had nothing of interest in her family history.

On interview, she had general weakness and easy fatigability. She also had anorexia, indigestion, and some weight loss. She continued to have cough and dyspnea, which aggravated on supine position and on exertion. On physical examination, she had normal blood pressure (BP) at 129/86 mm Hg. Heart rate was slightly elevated at 113 bpm, and her breathing was rather fast at 22 times per minute. Body temperature and oxygen saturation were normal. Her height was 161 cm, and her weight was 67 kg; she was overweight.

The patient was slightly anemic and icteric on examination. She was not dehydrated. On auscultation, coarse breath sounds with crackles in the right lower lung field, and rapid heartbeat with a soft systolic murmur could be heard. Abdomen was soft and flat without any tenderness, and no visible edema or cyanosis. Arterial blood gas analysis done at room air indicated normal O2 pressure and signs …