{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T05:07:25Z","timestamp":1775797645474,"version":"3.50.1"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>We report a 36-year-old male with pheochromocytoma presenting solely as progressive bilateral lower limb necrosis for 24 years, lacking classic symptoms (hypertension, headache, palpitations). Misdiagnosed as allergic vasculitis, he developed atrophic scars and toe necrosis despite immunosuppression. Elevated catecholamines and a 4.8\u00a0cm adrenal mass confirmed the diagnosis. Postoperatively, ulcers healed, but toe amputation was needed. This case highlights diagnostic pitfalls of atypical pheochromocytoma, emphasizing dynamic biomarker monitoring for early detection.<\/jats:p>","DOI":"10.3389\/fendo.2026.1773861","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T04:26:09Z","timestamp":1775795169000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A brief review and case report of pheochromocytoma misdiagnosed as allergic vasculitis with bilateral lower extremity ulcers: a 24-year clinical course"],"prefix":"10.3389","volume":"17","author":[{"given":"Rui","family":"Li","sequence":"first","affiliation":[{"name":"The First Clinical Medical College of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyi","family":"Cao","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heting","family":"Wei","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Dermatology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuping","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Dermatology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Le","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqing","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongye","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongzhou","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Dermatology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.36347\/sjmcr.2024.v12i11.001","article-title":"Familial bilateral pheochromocytoma complicated by acute ischemia of the lower limbs","volume":"12","author":"Boukhalfa","year":"2024","journal-title":"Sch J Med Case Rep"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2009.02095.x","article-title":"Phaeochromocytoma-associated critical peripheral ischaemia","volume":"40","author":"Lutchman","year":"2010","journal-title":"Intern Med J"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e31815c1df8","article-title":"Toe necrosis and acute myocardial infarction precipitated by a pheochromocytoma in a patient with systemic sclerosis","volume":"13","author":"Balbir-Gurman","year":"2007","journal-title":"J Clin Rheumatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2061","DOI":"10.1001\/archinte.1993.00410170147017","article-title":"Pheochromocytoma as a cause of blue toes","volume":"153","author":"Tack","year":"1993","journal-title":"Arch Intern Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2013-202845","article-title":"Acrocyanosis in a young adult: a rare presentation of extra-adrenal pheochromocytoma","volume":"2014","author":"Kumar","year":"2014","journal-title":"BMJ Case Rep"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1172\/jci105754","article-title":"Biochemical and pharmacologic effects of alpha-methyltyrosine in man","volume":"47","author":"Engelman","year":"1968","journal-title":"J Clin Invest"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1159\/000173959","article-title":"Clinical and biochemical aspects of pheochromocytoma. 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