Endocrine Abstracts

Introduction: Pheochromocytoma occasionally associates with pathological lesions of the adrenal cortex. We report a case of non-functional adrenocortical nodular hyperplasia with a concomitant pheochromocytoma in the controlateral adrenal and empty sella.

Case report: We describe the case of a 52 year old women with a history of essential hypertension and type 2 diabetes mellitus. She complained of: nausea, abdominal pain, vomiting and constipation. The computed tomography revealed a 5.3 cm left adrenal highly vascular tumor with multiple necrosis areas and a 3.5 cm well- encapsulated right adrenal mass. ACTH and plasma cortisol (after 1 mg dexametasone overnight test) levels were normal but the levels of urinary metanefrines were high. The patient was put on preoperative α-adrenoreceptor blockade and after 4 days due to important abdominal pain and lack of transit the surgery was performed and both adrenal glands were removed. Histopathological examination disclosed typical pheochromocytoma on the left side and nodular hyperplasia of the fasciculata on the right side. One month after surgery a full evaluation was made in order to exclude a multiple endocrine neoplasia: PTH and calcitonine levels were normal and the pituitary MRI revealed empty sella.

Conclusions: The present report is a rare case of pheochromocytoma with nodular hyperplasia of the fasciculata in the controlateral adrenal and empty sella. Also the diagnosis circumstances were unusual due to the clinical picture of acute abdomen and lack of endocrine manifestation of both adrenal masses.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.