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Case Reports in Endocrinology
Volume 2013, Article ID 815821, 5 pages
http://dx.doi.org/10.1155/2013/815821
Case Report

Malignant Catatonia Mimicking Pheochromocytoma

1Department of Pathology and Laboratory Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9
2Department of Medicine, Ridge Meadows Hospital, 11666 Laity Street, Maple Ridge, BC, Canada V2X 7G5
3Division of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9

Received 26 August 2013; Accepted 17 September 2013

Academic Editors: J. Broom and T. Nagase

Copyright © 2013 Sophia Wong et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Malignant catatonia is an unusual and highly fatal neuropsychiatric condition which can present with clinical and biochemical manifestations similar to those of pheochromocytoma. Differentiating between the two diseases is essential as management options greatly diverge. We describe a case of malignant catatonia in a 20-year-old male who presented with concurrent psychotic symptoms and autonomic instability, with markedly increased 24-hour urinary levels of norepinephrine at 1752 nmol/day (normal, 89–470 nmol/day), epinephrine at 1045 nmol/day (normal, <160 nmol/day), and dopamine at 7.9 μmol/day (normal, 0.4–3.3 μmol/day). The patient was treated with multiple sessions of electroconvulsive therapy, which led to complete clinical resolution. Repeat urine collections within weeks of this presenting event revealed normalization or near normalization of his catecholamine and metanephrine levels. Malignant catatonia should be considered in the differential diagnosis of the hypercatecholamine state, particularly in a patient who also exhibits concurrent catatonic features.