Chronic cannabis use as a confounding factor in the delayed diagnosis of phaeochromocytoma.

González S.; Minjarez B.; Piña Cedeño L.; Rodríguez-Yáñez Y. · Endocrinology, diabetes & metabolism case reports · 2026

**Background & Methods** This is a case report of a 37-year-old male with chronic daily cannabis use presenting with refractory hypertension and recurrent paroxysmal episodes of palpitations, diaphoresis, tremor, and anxiety. The clinical evaluation was initially misdirected toward psychiatric diagnoses until biochemical endocrine testing was performed following a period of sustained cannabis abstinence. **Key Findings** • Urinary fractionated metanephrines were markedly elevated: normetanephrine 6,114 μg/24 h (13.7-fold above normal; reference ≤445) and total metanephrines 11,662 μg/24 h (15.4-fold above normal; reference ≤757), confirming catecholamine excess. • Contrast-enhanced CT imaging identified a 6.0 × 5.0 cm left adrenal mass with imaging characteristics consistent with phaeochromocytoma; histopathology confirmed the diagnosis with a PASS (Pheochromocytoma of the Adrenal Gland Scaled Score) of 5. • Complete symptom resolution and normalization of blood pressure occurred following laparoscopic left adrenalectomy without antihypertensive therapy; patient remained asymptomatic and normotensive at 3-month follow-up. **Dosage & Administration** Not reported. The case documents chronic daily cannabis use without specification of dose, frequency, cannabinoid content, or route of administration. **Safety & Adverse Effects** Not reported as a primary outcome. The case highlights an unexpected clinical phenomenon: cannabis use appeared to attenuate catecholamine-related symptoms through a proposed CB1-mediated presynaptic mechanism reducing acetylcholine release at the adrenal medulla, thereby suppressing chromaffin cell stimulation and catecholamine secretion. **Evidence Quality** This is a single case report, representing the lowest level of clinical evidence (Level 5). The study lacks control groups, comparative analysis, and generalizability. The proposed mechanistic explanation for cannabis-mediated symptom attenuation is speculative and based on theoretical cannabinoid-acetylcholine interactions rather than empirical data. The case is valuable for generating clinical awareness and diagnostic hypotheses but cannot establish causation or prevalence. No experimental validation of the CB1-mediated mechanism is presented. The primary clinical significance lies in highlighting cannabis use as a potential diagnostic confounder that may mask endocrine pathology, with implications for clinical evaluation of hypertension and autonomic symptoms in cannabis users.

More recent cannabis research