{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:53Z","timestamp":1784557073908,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"\n Summary<\/jats:title>\n Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol\/day (89\u2013470)) and normetanephrine (initially 11.2 \u00b5mol\/day (0.6\u20132.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Obstructive sleep apnea (OSA) is a common condition among adults.<\/jats:p>\n <\/jats:list-item>\n \n OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety.<\/jats:p>\n <\/jats:list-item>\n \n OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-21-0100","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T05:55:08Z","timestamp":1645768508000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report"],"prefix":"10.1530","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6478-6394","authenticated-orcid":true,"given":"Aria","family":"Jazdarehee","sequence":"first","affiliation":[{"name":"Department of Medicine and Faculty of Medicine, University of British Columbia, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawyer","family":"Huget-Penner","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Fraser Health Authority, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Pawlowska","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, University of British Columbia, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Greenspan\u2019s Basic and Clinical Endocrinology","article-title":"Greenspan\u2019s basic and clinical endocrinology","author":"Gardner","year":"2017","unstructured":"Gardner DGShoback D. Greenspan\u2019s basic and clinical endocrinology. In Greenspan\u2019s Basic and Clinical Endocrinology [Internet], 10th ed. New York, NY: McGraw-Hill Education, 2017. (available at: accessmedicine.mhmedical.com\/content.aspx?aid=1144813132)"},{"key":"bib2","article-title":"RACGP \u2013 incidental adrenal masses \u2013 a primary care approach","author":"Gendy","unstructured":"Gendy RRashid P. RACGP \u2013 incidental adrenal masses \u2013 a primary care approach [Internet]. [cited 6 Sept 2021]. (available at: (https:\/\/www.racgp.org.au\/afp\/2017\/june\/incidental-adrenal-masses-a-primary-care-approach\/)"},{"key":"bib3","series-title":"New England Journal of Medicine","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1056\/NEJMra1806651","article-title":"Pheochromocytoma and paraganglioma","volume":"381","author":"Neumann","year":"2019","unstructured":"Neumann HPHYoung WFEng C. Pheochromocytoma and paraganglioma. New England Journal of Medicine2019381552\u2013565. (https:\/\/doi.org\/10.1056\/NEJMra1806651)10.1056\/NEJMra1806651"},{"key":"bib4","series-title":"Journal of Clinical Endocrinology and Metabolism","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1210\/jc.2014-1498","article-title":"Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","unstructured":"Lenders JWMDuh QYEisenhofer GGimenez-Roqueplo APGrebe SKGMurad MHNaruse MPacak KYoung WF & Endocrine Society. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism2014991915\u20131942. (https:\/\/doi.org\/10.1210\/jc.2014-1498)10.1210\/jc.2014-1498"},{"key":"bib5","series-title":"Endocrinology and Metabolism Clinics of North America","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.ecl.2019.08.004","article-title":"Pseudopheochromocytoma","volume":"48","author":"Mamilla","year":"2019","unstructured":"Mamilla DGonzales MKEsler MDPacak K. Pseudopheochromocytoma. Endocrinology and Metabolism Clinics of North America201948751\u2013764. (https:\/\/doi.org\/10.1016\/j.ecl.2019.08.004)10.1016\/j.ecl.2019.08.004"},{"key":"bib6","series-title":"Sleep Medicine Reviews","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.smrv.2016.07.002","article-title":"Prevalence of obstructive sleep apnea in the general population: a systematic review","volume":"34","author":"Senaratna","year":"2017","unstructured":"Senaratna CVPerret JLLodge CJLowe AJCampbell BEMatheson MCHamilton GSDharmage SC. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Medicine Reviews20173470\u201381. (https:\/\/doi.org\/10.1016\/j.smrv.2016.07.002)10.1016\/j.smrv.2016.07.002"},{"key":"bib7","series-title":"Journal of Clinical Endocrinology and Metabolism","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.1210\/jc.2003-031348","article-title":"Obstructive sleep apnea presenting as pseudopheochromocytoma: a case report","volume":"89","author":"Hoy","year":"2004","unstructured":"Hoy LJEmery MWedzicha JADavison AGChew SLMonson JPMetcalfe KA. Obstructive sleep apnea presenting as pseudopheochromocytoma: a case report. Journal of Clinical Endocrinology and Metabolism2004892033\u20132038. (https:\/\/doi.org\/10.1210\/jc.2003-031348)10.1210\/jc.2003-031348"},{"key":"bib8","series-title":"Journal of Investigative Medicine High Impact Case Reports","first-page":"2324709615607062","article-title":"The importance of exclusion of obstructive sleep apnea during screening for adrenal adenoma and diagnosis of pheochromocytoma","volume":"3","author":"Weeks","year":"2015","unstructured":"Weeks ACKimple MEDavis DB. The importance of exclusion of obstructive sleep apnea during screening for adrenal adenoma and diagnosis of pheochromocytoma. Journal of Investigative Medicine High Impact Case Reports201532324709615607062. (https:\/\/doi.org\/10.1177\/2324709615607062)"},{"key":"bib9","series-title":"Journal of Clinical Sleep Medicine","doi-asserted-by":"publisher","first-page":"190","DOI":"10.5664\/jcsm.27770","article-title":"Obstructive sleep apnea presenting as pseudopheochromocytoma","volume":"6","author":"Cheezum","year":"2010","unstructured":"Cheezum MKLettieri CJ. Obstructive sleep apnea presenting as pseudopheochromocytoma. Journal of Clinical Sleep Medicine20106190\u2013191. (https:\/\/doi.org\/10.5664\/jcsm.27770)10.5664\/jcsm.27770"},{"key":"bib10","series-title":"Clinical Chemistry","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1373\/clinchem.2014.224832","article-title":"Laboratory evaluation of pheochromocytoma and paraganglioma","volume":"60","author":"Eisenhofer","year":"2014","unstructured":"Eisenhofer GPeitzsch M. Laboratory evaluation of pheochromocytoma and paraganglioma. Clinical Chemistry2014601486\u20131499. (https:\/\/doi.org\/10.1373\/clinchem.2014.224832)10.1373\/clinchem.2014.224832"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2022\/1\/EDM21-0100.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM21-0100.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM21-0100.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:47:44Z","timestamp":1784555264000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":10,"URL":"https:\/\/doi.org\/10.1530\/edm-21-0100","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,1]]}}}