ACTH Secretion from a Functioning Pheochromocytoma

A PATIENT with hypertension, hirsutism, hyperglycemia, hypokalemic alkalosis and a transient paranoid psychosis was found to have hypercortisolism and increased excretion of catecholamines secondary to an ACTH-secreting pheochromocytoma. Fluctuations in plasma ACTH levels coincided with variations in urinary catecholamine excretion, suggesting that a common factor regulated peptide and catecholamine secretion in this patient. Adrenal-vein sampling revealed fourfold elevations in left-adrenal-vein ACTH and 10-fold elevations in left-adrenal-vein norepinephrine, when these values were compared with samples from the right adrenal vein and peripheral blood. After surgical removal of the left adrenal gland, urinary catecholamine levels returned to the normal range, whereas levels.