Endocrine Abstracts

Pheochromocytoma is a rare neuroendocrine tumour usually formed in the adrenal medulla. Percutaneous biopsy has been associated with life-threatening haemorrhage, hypertensive crisis, capsular disruption with tumour implantation and death. We present a case of a 63 years old woman with non-specific clinical signs which included high blood pressure, headache, tachycardia and abdominal pain. She was treated for rheumatoid arthritis. Bilateral expansion of adrenal gland with delayed wash-out, on the right site 45 × 20 × 40 mm with cystic necrosis and 25 mm on the left site. In the liver there were unclear foci, not typical for a cyst or haemangioma. The radiological diagnosis was not clear. Therefore for fear of malignancy percutaneous biopsy under ultrasonic control was performed before the knowledge of metanephrine levels. Plasma metanephrines were available later. The level of metanephrine level was 0.45 nmol/l (normal range 0.06–0.31) and of normetanephrine was 4.64 nmol/l (normal range 0.1–0.61), respectively. Other screening tests done to exclude the other tumours that are connected to the inherited syndrome were negative. No mutation in RET proto-oncogene was found. Bilateral laparoscopic adrenalectomy was performed after pre-treatment with alpha-1 blocker Doxazosin. In this case, fortunately, complications related to the biopsy of pheochromocytoma did not occur. However, tumours suspected to be a pheochromocytoma or paraganglioma should not have a biopsy, unless it is absolutely necessary to confirm a diagnosis.