Isolated Recurrent Syncope as the Initial Presentation of Pheochromocytoma: A Case Report of a Hidden Catecholamine-Secreting Tumor
- 1Department of General Medicine, Peoples’ Friendship University of Russia, Moscow, Russian Federation
- 2Department of Internal Medicine, University of Balamand, Beirut, Lebanon
- 3Department of Cardiology, University of Balamand, Beirut, Lebanon
Abstract
Syncope is a common clinical presentation, yet a substantial proportion of cases remain unexplained despite guideline-directed evaluation. Pheochromocytoma, although a well-recognized catecholamine-secreting tumor, rarely presents with syncope, particularly in the absence of classical adrenergic symptoms, leading to diagnostic delay. We report a 60-year-old previously healthy female with recurrent episodes of transient loss of consciousness over two months, characterized by abrupt onset, brief duration, and complete spontaneous recovery without prodromal or postictal features. Despite repeated emergency presentations and an extensive negative workup including serial electrocardiograms, continuous cardiac monitoring, transthoracic echocardiography, orthostatic testing, tilt-table testing, carotid sinus massage, neurological evaluation, brain imaging, and laboratory studies, no cause was identified. Electrocardiography was normal and D-dimer testing excluded pulmonary embolism. Diagnosis was ultimately suggested by physical examination revealing a right flank mass, with abdominal computed tomography demonstrating a 5.6 cm adrenal lesion and biochemical testing confirming markedly elevated plasma free metanephrine (3.8 nmol/L; reference <0.50 nmol/L) and normetanephrine (9.6 nmol/L; reference <0.90 nmol/L), consistent with pheochromocytoma. Following appropriate preoperative preparation and surgical resection, the patient experienced complete resolution of syncope. This case highlights pheochromocytoma as a rare but reversible cause of recurrent unexplained syncope and underscores a potential diagnostic limitation of standard syncope workup, where intermittent catecholamine surges may evade detection, reinforcing the continued value of thorough physical examination in refractory cases.
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BibTeX
@article{murr2026isolated,
title = {{Isolated Recurrent Syncope as the Initial Presentation of Pheochromocytoma: A Case Report of a Hidden Catecholamine-Secreting Tumor}},
author = {Nabil El Murr and Antonio Al Hazzouri and Elias El Murr and Omar Msadi and Katherine Atallah and Sari Khater and Maroun Breidy},
journal = {Clinical Medicine Insights. Case Reports},
year = {2026},
month = sep,
doi = {10.1177/11795476261492354},
url = {https://doi.org/10.1177/11795476261492354},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Isolated Recurrent Syncope as the Initial Presentation of Pheochromocytoma: A Case Report of a Hidden Catecholamine-Secreting Tumor
AU - Nabil El Murr
AU - Antonio Al Hazzouri
AU - Elias El Murr
AU - Omar Msadi
AU - Katherine Atallah
AU - Sari Khater
AU - Maroun Breidy
PY - 2026
DA - 2026/09/18
JO - Clinical Medicine Insights. Case Reports
DO - 10.1177/11795476261492354
UR - https://doi.org/10.1177/11795476261492354
AB - Syncope is a common clinical presentation, yet a substantial proportion of cases remain unexplained despite guideline-directed evaluation. Pheochromocytoma, although a well-recognized catecholamine-secreting tumor, rarely presents with syncope, particularly in the absence of classical adrenergic symptoms, leading to diagnostic delay. We report a 60-year-old previously healthy female with recurrent episodes of transient loss of consciousness over two months, characterized by abrupt onset, brief duration, and complete spontaneous recovery without prodromal or postictal features. Despite repeated emergency presentations and an extensive negative workup including serial electrocardiograms, continuous cardiac monitoring, transthoracic echocardiography, orthostatic testing, tilt-table testing, carotid sinus massage, neurological evaluation, brain imaging, and laboratory studies, no cause was identified. Electrocardiography was normal and D-dimer testing excluded pulmonary embolism. Diagnosis was ultimately suggested by physical examination revealing a right flank mass, with abdominal computed tomography demonstrating a 5.6 cm adrenal lesion and biochemical testing confirming markedly elevated plasma free metanephrine (3.8 nmol/L; reference <0.50 nmol/L) and normetanephrine (9.6 nmol/L; reference <0.90 nmol/L), consistent with pheochromocytoma. Following appropriate preoperative preparation and surgical resection, the patient experienced complete resolution of syncope. This case highlights pheochromocytoma as a rare but reversible cause of recurrent unexplained syncope and underscores a potential diagnostic limitation of standard syncope workup, where intermittent catecholamine surges may evade detection, reinforcing the continued value of thorough physical examination in refractory cases.
SN - 1179-5476
ER -