Abstract

ALS is a progressive neurodegenerative disorder involving both upper and lower motor neurons. Paraneoplastic manifestation of ALS has been reported in association with certain cancers such as parathyroid hormone-related peptideinduced hypercalcemia, acromegaly, gynecomastia, gastric cancer. We present a 60-year-old male patient who was hospitalized multiple times for recurrent falls due to bilateral lower extremity weakness and painful muscle cramps. Physical exam findings revealed diffuse fasciculation is, atrophy and cramps suggestive of moto neuron disease. Work up revealed elevated 24 hours urine metanephrines and adrenal mass on abdominopelvic computerized tomography CT scan. He underwent laparoscopic resection of the tumour with histopathology confirming pheochromocytoma. Amyotrophic lateral sclerosis was later confirmed with nerve conduction study and electromyography.