There are so many fascinating cases in medicine that can leave you amazed, and today I want to share one such interesting case I came across.
Imagine a man, about 50 years old, who comes to you complaining of repeatedly losing consciousnes, fainting, in the bathroom right after urinating. This had happened three times recently, and each time, he was rushed to the hospital to be resuscitated. Surprisingly, every time they checked him, they found nothing wrong. His brain, one of the first places doctors check in cases of fainting, was fine. His heart, another critical organ to examine, was also healthy.
When someone faints, doctors typically look at three main things: the brain, the heart, and blood sugar levels. Low blood sugar (hypoglycemia) can cause fainting, but that wasn’t the case here. They also considered shock from an infection or other conditions, but nothing matched. It was a mystery.
One possibility that crossed our minds was a vasovagal response, a sudden drop in blood pressure and heart rate triggered by stimulation of the vagal nerve. But there was no obvious trigger for this response in his case. We also checked for increased parasympathetic tone, which can cause blood vessels to dilate and lead to a drop in blood pressure, but that wasn’t the issue either.
We ruled out dehydration, which can sometimes cause fainting, as well as prostate issues like benign prostatic hyperplasia (BPH), which can lead to pressure changes during urination. At 50 years old, he wasn’t at high risk for severe causes of syncope (fainting), and he had no history of neurological disorders or medications like diuretics or sedatives that could contribute to fainting.
After a thorough evaluation, we decided to perform a CT scan of his abdomen, suspecting something hormonal. The results showed deranged hormone levels, leading us to discover a paraganglioma—a rare tumor located near his bladder. This tumor was the cause of his post-micturition syncope (fainting after urination).
It is an extraadrenal pheochromocytoma also know as organ of Zuckerkandl in this case is a neuroendocrine tumor that usually originates from the adrenal medulla, the inner part of the adrenal glands located above the kidneys. These tumors are composed of chromaffin cells, which secrete catecholamines like adrenaline (epinephrine) and noradrenaline (norepinephrine). They can cause symptoms like episodic high blood pressure, headaches, excessive sweating, and, in this case, after urination the bladder triggers the organ of zuckerkandl which release a vasovagal trigger causing fainting after urination.
About 90% of these tumors are benign, while 10% can be malignant. Once we identified the cause, the patient was referred for specialized treatment and follow-up.
This case is a wonderful learning experience and a reminder of how complex and fascinating medicine can be. It’s a field that constantly challenges us to think deeply and explore every possibility.
I hope you found this case as interesting as I did. Medicine truly is a beautiful thing to learn and practice.
Images were generated using MetaAI
Jaydr