Document Type : Case Report
Authors
- Reza Mohammadi 1
- Mohammadamin Hesamarefi 1
- Mohammadhadi Hesam-Arefi 2
- Mohammadali Bagherinasabsarab 1
1 Department of Urology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
2 Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
Abstract
Background: Pheochromocytoma and Paraganglioma can secrete excess Catecholamines, causing hypertension, tachycardia, hyperhidrosis, or shock. Measuring blood and urine Metanephrine levels helps with a proper diagnosis. Tumor localization can be performed using Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). Tumors can also present as an asymptomatic adrenal incidentaloma, identified radiographically. Here, we report one such interesting case.
Case report: A 48-year-old woman was referred to us with an 8.9 × 9.4 cm right adrenal incidentaloma, as measured by computed tomography (CT) scan. She was totally asymptomatic, with normal blood pressure both before and after the operation. Repeated biochemical screening remained within normal range. The patient underwent right adrenalectomy (via a subcostal incision), and histological findings confirmed Pheochromocytoma.
Conclusion: This case illustrates how radiologic findings in an asymptomatic and biochemically negative patient can alert to the presence of a Pheochromocytoma.
Keywords
- Pheochromocytoma
- Incidentaloma
- Hypertension
- Biochemically negative
- Asymptomatic
- Computed tomography
- Magnetic resonance imaging
Main Subjects
- Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915–42. doi:10.1210/jc.2014-1498
- Kantorovich V, Pacak K. New insights on the pathogenesis of paraganglioma and pheochromocytoma. F1000Res. 2018;7. doi:10.12688/f1000research.14568.1
- Bravo EL, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev. 2003;24(4):539–53. doi:10.1210/er.2002-0013
- Spiro A, Usman A, Ajmal A, Hoang TD, Shakir MKM. Asymptomatic and Biochemically Silent Pheochromocytoma with Characteristic Findings on Imaging. Case Rep Endocrinol. 2020;2020:8847261. doi:10.1155/2020/8847261
- Reisch N, Peczkowska M, Januszewicz A, Neumann HP. Pheochromocytoma: presentation, diagnosis and treatment. J Hypertens. 2006;24(12):2331–9. doi:10.1097/01. hjh.0000251887.01885.54
- Bravo EL, Gifford RW, Jr. Current concepts. Pheochromocytoma: diagnosis, localization and management. N Engl J Med. 1984;311(20):1298–303. doi:10.1056/ nejm198411153112007
- Barzon L, Sonino N, Fallo F, Palu G, Boscaro M. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149(4):273–85. doi:10.1530/eje.0.1490273
- Lee JA, Zarnegar R, Shen WT, Kebebew E, Clark OH, Duh QY. Adrenal incidentaloma, borderline elevations of urine or plasma metanephrine levels, and the “subclinical” pheochromocytoma. Arch Surg. 2007;142(9):870–3; discussion 73–4. doi:10.1001/archsurg.142.9.870
- Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT, Pitman MB, Harisinghani M, et al. Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol. 2003;181(6):1663–8. doi:10.2214/ ajr.181.6.1811663
- Kota SK, Kota SK, Panda S, Modi KD. Pheochromocytoma: an uncommon presentation of an asymptomatic and biochemically silent adrenal incidentaloma. Malays J Med Sci. 2012;19(2):86–91.
- Dobri GA, Bravo E, Hamrahian AH. Pheochromocytoma: pitfalls in the biochemical evaluation. Expert Rev Endocrinol
Metab. 2014;9(2):123–35. doi:10.1586/17446651.2014.887 985
- Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery. 1991;110(6):1014–21.
- Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006;29(4):298–302. doi:10.1007/bf03344099
- Willatt JM, Francis IR. Radiologic evaluation of incidentally discovered adrenal masses. Am Fam Physician. 2010;81(11):1361–6.
- Crout JR, Sjoerdsma A. Turnover and metabolism of catecholamines in patients with pheochromocytoma. J Clin Invest. 1964;43(1):94–102. doi:10.1172/jci104898
- Eisenhofer G, Goldstein DS, Kopin IJ, Crout JR. Pheochromocytoma: rediscovery as a catecholamine-metabolizing tumor. Endocr Pathol. 2003;14(3):193–212. doi:10.1007/s12022-003-0012-4
)