Death From Pheochromocytoma Initially Suspected Of Being A Homicide
INTRODUCTION: Homicides require a great deal of time, effort, and resources from police and forensic professionals. Occasional cases occur wherein initial evaluation suggests that a homicide has occurred, but after autopsy, the death is actually determined to be the result of natural disease.
PURPOSE: We present a case of adrenal pheochromocytoma initially presenting as a suspected homicide.
MATERIALS: This case is selected from the files of one of the authors (JP).
RESULTS: A 66-year-old male was found dead in his residence, with a pool of blood surrounding his head, which had evidence of trauma. The case was initially considered suspicious for homicide. Upon further investigation, however, most of the head injuries appeared to be consistent with postmortem rodent feeding, with no lethal injuries identified. Autopsy revealed a 7 cm, mostly solid mass in the right adrenal medulla, as well as a markedly-enlarged heart (750g), with coronary artery atherosclerosis, and kidney findings consistent with hypertension. Microscopic analysis of the adrenal tumor confirmed the diagnosis of pheochromocytoma. The cause of death was certified as being due to hypertensive and atherosclerotic cardiovascular disease, with a contributing factor of an underlying pheochromocytoma.
DISCUSSION/CONCLUSION: Pheochromocytomas have varied clinical manifestations and represent a situation in which surgical tumor resection may be curative of hypertension. This case highlights the importance of clinical screening for uncommon etiologies of hypertension. The case also demonstrates that cause of death determination can be complicated by factors such as postmortem animal activity, accidental trauma, and rare diseases.