Endocrine Abstracts

Pheochromocytoma is a rare tumor of the adrenal medulla, responsible for excessive secretion of catecholamines. Symptoms include the classic triad: headache, palpitations and sweating, usually accompanied by hypertension. We report the case of a pheochromocytoma diagnosed following an episode of testicular necrosis. A 72-year-old patient with history of psoriasis and prostate resection underwent emergency surgery for increased testicular pain suspicious of testicular tumor. Pathological examination revealed testicular necrosis due to vascular damage. The patient was addressed to internal medicine consultation for etiological assessment of the vascular lesion. Testing for autoimmune etiology including SAPL, AAN and ANCA antibodies, as well as for a thromboembolic pathology were negative. A full body CT scan found a 14 × 16 mm right adrenal adenoma (60% absolute washout) and a 32 × 29 mm heterogeneous mass of the left adrenal. The left adrenal mass was hyperfunctional in MIBG scintigraphy. Hormonal exploration found plasma normetanephrines increased 3 × normal, with normal plasma metanephrines and normal plasma dopamine and no other abnormality. Chromogranin A was slightly increased. On further interrogation, the patient reported some palpitation episodes several months earlier. A 24 h ECG was performed finding rare atrial and ventricular extrasystoles. First surgery attempt was unsuccessful, with tachycardia followed by bradycardia and cardio respiratory arrest with successful CPR. The patient finally underwent left adrenalectomy by laparotomy with hemostasis splenectomy. Anatomo-pathological examination confirmed a 2 cm left adrenal pheochromocytoma with an estimated PASS score of 6. Normalization of plasma normetanephrines was observed after surgery. This is, to our knowledge, the first case in the literature of a non-traumatic, spontaneous testicular necrosis revealing a pheochromocytoma. There are a few observations of skin necrosis or distal ischemia revealing a pheochromocytoma, however these remain rare. The hypothesis put forward is the appearance of ischemic lesions after adrenergic discharges. Sympathetic hypertonicity would be at the origin of vascular spasms and an alteration of the microcirculation.