Endocrine Abstracts

Introduction: Cystic adrenal neoplasms are uncommon and were defined with foci of tumor presented in the cyst wall. Adrenal cortical adenoma, adrenal cortical carcinoma and pheocromocytoma may be associated. We report a case of functioning cystic pheocromocytoma.

Case report: A 44-year-old man had abdominal pain on the right side. Abdominal ultrasonography showed a noduler cystic lesion measured 4 cm in diameter with thin septas and thickened wall in the right adrenal. Computed tomography confirmed hypodense lesion with a density of 40 HU. Magnetic resonance imaging supported the diagnosis of cystic adrenal lesion which was not suppressed with fat-suppressed sequence. He had a mild hypertension. As a medical therapy amlodipin and doxazosin were begun for hypertension and preoperative management. Twenty-four-hour urine analysis demonstrated elevated excretion of metanephrine (368.7 μg/day (52–341)), normetanephrine (495.9 μg/day (88–444)) and vanil mandelic acid (46.8 mg/day (1.4–6.5)). Tests were negative for hypercortisolism and primary hyperaldosteronism. Preoperative iodine-123 MIBG SPECT images showed right adrenal lesion accumulation. He underwent a right adrenalectomy with minimal invasive-laparoscopic surgery. Anesthetic induction was performed with fentanyl, propofol, rocuronium and lidocaine. During manuplation of adrenal lesion three hypertensive attacks occurred. Infusion of nitroglycerine, nitroprusside and diltiazem were given to control hypertensive attacks. Postoperative he was normotensive and did not need any replacement therapy. Pathology was cystic benign pheocromocytoma.

Conclusion: Adrenal cysts may be incidental or symptomatic and are classified as pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. Necrosis or haemorrhage leading to cystic dilatation has been designated to be the pathogenesis of cystsic pheocromocytoma. We report a case of cystic pheocromocytoma who was symptomatic and biochemically functioning.