Case PresentationĪ 53-year-old woman was referenced from primary care physician to her local hospital due to fever at evening and a weight loss of 5% in one month. In this report, we describe a patient with a pheochromocytoma and elevated plasma IL-6 that presented with SIRS. It is produced mainly by lymphocytes and monocytes and is physiologically expressed in the adrenal cortex, but not in adrenal medulla.

IL-6 also regulates hematopoiesis and stimulates hypothalamic-pituitary-adrenal axis.

IL-6 is a cytokine that regulates immune responses and plays a major role in inflammatory cascade by stimulating the release of acute-phase reactants such as C-reactive protein (CRP). The SIRS consists in a pathophysiologic response to a nonspecific insult and is characterized by fever or hypothermia, tachycardia, tachypnea, and/or leukocytosis. Fever of unknown origin is uncommon in patients with pheochromocytoma, but there are few reports of patients with systemic inflammatory response syndrome (SIRS) and elevated IL-6 plasma levels due to this adrenal tumor. Some of these are cytokines, mainly interleukin-1 (IL-1), IL-6, tumor necrosis factor- α (TNF- α), and interferon- γ (INF- γ), resulting in systemic inflammation. However, some of these tumors may secrete other hormones or neuropeptides, resulting in unusual clinical manifestations and hindering the diagnosis. Pheochromocytoma is a tumor that arises from chromaffin cells of adrenal medulla and usually presents with paroxysms of hypertension, palpitations, sweating, and headache due to excessive catecholamine release. To our knowledge, this is the first case report of IL6-producing pheochromocytoma along with autonomous cortisol production. After adrenalectomy, the inflammatory syndrome resolved and all biochemical parameters normalized, including IL-6 and ACTH. She also presented biochemical evidence of ACTH-independent cortisol production without overt Cushing syndrome. In this setting, interleukin-6 (IL-6) was requested and was elevated.

We report the case of a 53-year-old female patient with a pheochromocytoma that presented with fever and weight loss of 5% in one month along with normocytic anemia, thrombocytosis, leukocytosis, and elevated C-reactive protein.

Systemic inflammatory response syndrome (SIRS) can be a rare manifestation of pheochromocytoma, since this adrenal tumor may produce cytokines and other hormones or neuropeptides besides catecholamines.

Cortisol producing tumor