A Case Report of Pheochromocytoma Presenting With a Tongue Sign Indicative of Blood Deficiency.

Pheochromocytoma is a rare neuroendocrine tumor presenting with varied clinical symptoms. We present a unique case of pheochromocytoma in a 46-year-old male who developed paroxysmal palpitations, headaches, and elevated blood pressure. Notably, his tongue showed atypical signs of blood deficiency (pale white, thin, and emaciated appearance), which we attributed to peripheral vasoconstriction from sympathetic hyperactivity. His pulse and abdominal findings aligned with qi counterflow in Kampo medicine (traditional Japanese herbal medicine). Despite treatment with Saikokaryukotsuboreito, a traditional herbal formula prescribed to address qi counterflow, only partial improvement of neuropsychiatric symptoms was observed. Further evaluation by an endocrinology specialist confirmed the diagnosis of pheochromocytoma through advanced diagnostic modalities, including scintigraphy. Pheochromocytoma is known to induce sympathetic hyperactivity via excessive catecholamine production, resulting in peripheral vasoconstriction and compromised blood flow, particularly in distal areas such as the tongue.  This case illustrates that sympathetic hyperactivity can produce tongue signs mimicking blood deficiency patterns. Recognition of this discrepancy between tongue signs and other clinical findings prompted further investigation, leading to the diagnosis of pheochromocytoma through modern diagnostic methods. Our experience demonstrates how the integration of Kampo and Western diagnostic approaches enables accurate diagnosis of underlying conditions.