Endocrine Abstracts

Introduction: Giant cystic phaeochromocytomas are an exceedingly rare variant of adrenal phaeochromocytomas. We report a case in an 83-year-old lady who initially presented with a swinging pyrexia, initially diagnosed as a hepatic abscess.

Case report: An 83-year-old lady with a history of hypertension was admitted as an emergency with nausea and vomiting, dehydration and rigors. She was pyrexial and dehydrated; pulse 163 and BP 167/86. There were signs of mild congestive cardiac failure. There was fullness in the right abdominal region. Inflammatory markers were elevated. She was treated for intra-abdominal sepsis. CT abdomen revealed a large right liver lobe cystic lesion 12×14 cm. Aspiration followed by a drain was inserted under USS guidance. 1.3 L of blood-stained serous fluid was drained. The patient improved clinically, but following removal of the drain, she relapsed. A further drain was inserted but the repeat CT scan now indicated a partially collapsed mass separate from the liver, and the right adrenal gland could not be visualised. Cyst cultures isolated E. coli that responded to a prolonged course of IV antibiotics. Hydatid ELISA was negative. 24 h urine collection: metanephrines 59.0 μmol/l (<2.0) and normetanephrines 34.6 μmol/l (<4.4); cortisol 328 nmol (50–350). MIBG scintigraphy showed persistent uptake with no evidence of multi-focal disease. Echocardiogram showed moderate LV dysfunction. The patient was initiated on phenoxybenzamine followed by bisoprolol with clinical improvement of her hypertension, tachycardia and cardiac function. She was referred for consideration regarding adrenalectomy. However, it was decided that conservative management with optimised medical treatment was more appropriate.

Conclusions: Large cystic phaeochromocytomas are very rare and may be asymptomatic. As far as we are aware, this is the first report of an infected cystic phaeochromocytoma manifesting as an acute abdomen, and although atypical, should be considered as a differential diagnosis.