ECE2019 Poster Presentations Thyroid 1 (70 abstracts)
Giant cystic pheochromocytoma: A clinically silent entity
Aikaterini Afentoulidi 1 , Haridimos Markogiannakis 2 , Panagiotis Kekis 3 , Maria Natoudi 2 , Stavroula Gavriilidou 1 , Constantinos Belis 1 , Kalliopi Xydiari 1 , Vasileios Athanasiou 1 , Sofia Malaktari-Skarantavou 1 , Emmanouil Leandros 2 & Christos Savvidis 1
1Department of Endocrinology and Metabolism, Hippocratio General Hospital of Athens, Athens, Greece; 21st Department of Propaedeutic Surgery, Hippocratio General Hospital of Athens, Medical School, National and Kapodistrian University of Athens, Athens, Greece; 3Athens Medical Center, Athens, Greece.
Introduction: Pheochromocytomas (PCCs) are rare neuroendocrine catecholamine secreting-tumors derived from chromaffin cells of the adrenal medulla. PCCs are usually solid tumors but rarely occur as a cystic lesion. Cystic pheocromocytomas (CPCCs) are usually asymptomatic, unilateral and of a large size without typical radiological and biochemical features of pheochromocytomas. Non-specific abdominal pain has been reported in several cases.
Case Presentation: We present a case of a 48-year-old female patient who is referred to our department due to an incidentally discovered large left adrenal mass, detected during preoperative imaging test for bariatric surgery. The patient was obese but with no Cushingoid features or other signs of hormonal excess. She did not report headache, palpitations, excessive sweating or hypertension. On clinical examination her pulse rate was 80 beats/min and her blood pressure was 120/70 mmHg. Blood count, liver and renal function tests were within normal range. A complete laboratory test of adrenal function was performed, which was negative for excess secretion of catecholamines or their metabolites. CT scan of the abdomen revealed a mass of 9.3 cm in diameter in the left adrenal gland. MRI revealed central cystic compartment and hemorrhagic areas in the above mentioned mass. The patient underwent open left transabdominal adrenalectomy without any intra- or perioperative complications. Histological section revealed morphological features of pheochromocytoma with cystic degeneration. Immunohistopathological staining was positive for chromogranin A and synaptophysin.
Conclusion: In contrast to patients with solid pheochromocytomas patients with cystic pheochromocytomas are usually asymptomatic and they have a negative biochemical evaluation which may lead to misdiagnosis. Consequently, the time of diagnosis is delayed, and tumor size tends to be larger once is detected. In this report, we present a case of a 48-year-old female patient with a giant cystic pheochromoytoma, who was asymptomatic and with normal biochemical profile. The presence of a pheochromocytoma should be considered in the differential diagnosis of cystic adrenal lesions even in the absence of symptoms or abnormal biochemical profile, because of the potential hemodynamic instability during surgery as it was published in other case reports.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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