Endocrine Abstracts

Introduction: Pheochromocytomas are rare neuroendocrine tumors producing catecholamines, they are usually unilateral. However, they can be located bilaterally. They still pose several problems in their diagnosis if they are associated with an adrenal cyst, which is the case in our patient.

Case Report: A 34-years-old male patient, his medical and family histories were non specific, admitted to the emergency room for lumbar pain, with no other associated signs, Abdominal computed tomography showed a well-demarcated cystic mass 86*76 mm with a thick wall in the region of the right adrenal gland and a left adrenal nodule of 15*18 mm, 24 hrs urine metanephrine and normetanephrine were significantly elevated metanephrine: 4.81 mg/24 h (0.04-0.30), normetanephrine : 8,73 mg/24 h (0.07-0.46). After adequate medical blockade and hydration, bilateral adrenalectomy has been performed endoscopically, The postoperative course was simple. Anatomopathological analysis showed a right cystic pheochromocytoma, and a left pheochromocytoma with no sign of malignancy. A genetic study was performed was without particularities. The evolution was favorable under replacement therapy with 30 mg/d of hydrocortisone.

Discussion: Pheochromocytoma is a tumor arising from adrenomedullary chromaffin cells that commonly produce one or more catecholamines: Epinephrine, Norepinephrine and Dopamine. Pheochromocytoma can present as cystic lesions, which may mislead the diagnosis. Pheochromocytoma should be considered in patients presenting with non specific symptoms and an incidental cystic adrenal mass, even in the absence of hypertension. A typical solid pheochromocytoma can be easily diagnosed with available diagnostic methods. However, it is difficult to diagnose cystic pheochromocytoma since it structurally resembles a benign adrenal cyst. Structural imaging may be inconclusive. Functional imaging like MIBG scan is essential to prove the presence of sympatho-adrenal tissue.

Conclusion: In any patient presenting with abdominal pain, and adrenal cystic lesion, pheochromocytoma should be suspected, because it is a rare entity and is mostly asymptomatic, and complete with a genetic study in case of bilateral involvement.

Reference: 1. J Clin Diagn Res. 2016 Nov; 10(11): OD09–OD10.