[Recurrent paroxysmal neck swellings as the primary manifestation of a pheochromocytoma].

A 45-year-old female had been suffering for about 6 months almost daily from paroxysmal neck swellings with occasional difficulties in swallowing and from non-specific abdominal complaints. Hormone analyses, performed because of the marked blood pressure increase up to 210/120 mm Hg during such an attack, revealed an increase in vanillyl mandelic acid and epinephrine concentrations in the 24-hour urine. CT demonstrated a tumour of 4 x 5 x 5 cm size in the region of the right adrenal. The paroxysmal neck swellings and blood pressure increase could be reproduced by means of pressure applied over the tumour range with the ultrasound transducer. The tumour was extirpated and histology revealed a phaeochromocytoma. For more than one year now the patient has been free from complaints. To date, recurrent neck swellings have not been reported in association with a phaeochromocytoma. Possible causes may be an enhanced congestion of the deep neck vessels during paroxysmal blood pressure increase or an enhanced response by the adrenoreceptors of these vessels to the released catecholamines.