{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:58Z","timestamp":1784557018417,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,4,12]],"date-time":"2018-04-12T00:00:00Z","timestamp":1523491200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4,12]]},"abstract":"<jats:p>A 54-year-old woman was admitted to hospital with a presumed allergic reaction to a single dose of amoxicillin given for a suspected upper respiratory tract infection. She complained of chest tightness although there was no wheeze or stridor. On examination, she was pyrexial, tachycardic, hypertensive and had a diffuse mottled rash on her lower limbs. Her initial investigations showed raised inflammatory markers. She was treated in the intensive care for a presumed anaphylactic reaction with an underlying sepsis. Further investigations including CT head and CSF examination were unremarkable; however, a CT abdomen showed a 10\u2009cm heterogeneous right adrenal mass. Based on review by the endocrine team, a diagnosis of pheochromocytoma crisis was made, which was subsequently confirmed on 24-h urinary metanephrine measurement. An emergency adrenalectomy was considered although she was deemed unfit for surgery. Despite intensive medical management, her conditioned deteriorated and she died secondary to multi-organ failure induced by pheochromocytoma crisis.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Pheochromocytoma have relatively higher prevalence in autopsy series (0.05\u20131%) suggestive of a diagnosis, which is often missed.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Pheochromocytoma crisis is an endocrine emergency characterized by hemodynamic instability induced by surge of catecholamines often precipitated by trauma and medications (\u03b2 blockers, general anesthetic agents, ephedrine and steroids).<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Pheochromocytoma crisis can mimic acute coronary syndrome, cardiogenic or septic shock.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Livedo reticularis can be a rare although significant cutaneous marker of underlying pheochromocytoma crisis.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-17-0170","type":"journal-article","created":{"date-parts":[[2018,4,12]],"date-time":"2018-04-12T11:01:59Z","timestamp":1523530919000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":3,"title":["Livedo reticularis: a cutaneous clue to an underlying endocrine crisis"],"prefix":"10.1530","volume":"2018","author":[{"given":"Natasha","family":"Shrikrishnapalasuriyar","sequence":"first","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirena","family":"Noyvirt","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Evans","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Gibson","sequence":"additional","affiliation":[{"name":"2Department of Intensive Care, Royal Glamorgan Hospital, Llantrisant, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Foden","sequence":"additional","affiliation":[{"name":"2Department of Intensive Care, Royal Glamorgan Hospital, Llantrisant, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Kalhan","sequence":"additional","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref131","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1186\/s13104-015-1738-z","article-title":"Phaeochromocytoma multisystem crisis treated with emergency surgery: a case report and literature review.","volume":"8","year":"2015","journal-title":"BMC Research Notes"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1210\/jc.2012-2842","article-title":"Livedo reticularis in a patient with phaeochromocytoma resolving after adrenalectomy.","volume":"98","year":"2013","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1177\/003591577106401209","article-title":"Phaeochromocytoma with livedo reticularis.","volume":"64","year":"1971","journal-title":"Proceedings Royal Society Medicine"},{"key":"ref21","first-page":"J5674","article-title":"Management of incidental adrenal tumours","volume":"360","year":"2018","journal-title":"British Medical Journal"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1001\/archsurg.1988.01400320042007","article-title":"Phaeochromocytoma multisystem crisis. A surgical emergency","volume":"123","year":"1988","journal-title":"Archives of Surgery"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1186\/s13104-015-1738-z","article-title":"Phaeochromocytoma multisystem crisis treated with emergency surgery: a case report and literature review.","volume":"8","year":"2015","journal-title":"BMC Research Notes"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1177\/003591577106401209","article-title":"Phaeochromocytoma with livedo reticularis.","volume":"64","year":"1971","journal-title":"Proceedings Royal Society Medicine"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1210\/jc.2012-2842","article-title":"Livedo reticularis in a patient with phaeochromocytoma resolving after adrenalectomy.","volume":"98","year":"2013","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1530\/EJE-07-0778","article-title":"Phaeochromocytoma crisis induced by glucocorticoids: a report of 4 cases and review of the literature.","volume":"158","year":"2008","journal-title":"European Journal of Endocrinology"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1530\/EJE-07-0778","article-title":"Phaeochromocytoma crisis induced by glucocorticoids: a report of 4 cases and review of the literature.","volume":"158","year":"2008","journal-title":"European Journal of Endocrinology"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1210\/er.2002-0031","article-title":"The clinically inapparent adrenal mass: update in diagnosis and management","volume":"25","year":"2004","journal-title":"Endocrine Reviews"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1001\/archsurg.1988.01400320042007","article-title":"Phaeochromocytoma multisystem crisis. A surgical emergency","volume":"123","year":"1988","journal-title":"Archives of Surgery"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1210\/er.2002-0031","article-title":"The clinically inapparent adrenal mass: update in diagnosis and management","volume":"25","year":"2004","journal-title":"Endocrine Reviews"},{"key":"ref91","first-page":"J5674","article-title":"Management of incidental adrenal tumours","volume":"360","year":"2018","journal-title":"British Medical Journal"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2018\/1\/EDM17-0170.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2018\/1\/EDM17-0170.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:46:47Z","timestamp":1784555207000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,12]]},"references-count":14,"URL":"https:\/\/doi.org\/10.1530\/edm-17-0170","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,12]]}}}