Endocrine Abstracts

Introduction: Pheochromocytomas (PCCs) or adrenal paragangliomas are neuroendocrine non-epithelial catecholamine-producing tumors with a wide range of cardiovascular, metabolic, neurological manifestations, which may complicate the early diagnosis of the disease in some cases.

Materials and methods: We analyzed data from 89 patients (58 women, 31 men, median age 52 years) with histologically and immunohistochemically verified PCCs including 4 patients with bilateral PCCs.

Results: The most common symptom was hypertension which was observed in 78 (85%) patients including 67 (73%) patients with paroxysmal hypertension, and 11 (12%) patients with sustained hypertension. Median blood pressure (BP) was 200/107mm Hg, the majority (75%) of patients had BP grade III (ESH/ESC 2018). Episodes of tachycardia were observed in 34 (37%) patients. The other most common symptoms were headaches (n=47, 51%), pain in the lumbar region (n=20, 22%) and sweating (n=16, 17%). According to biochemical data, mixed type of secretion predominated (59%), noradrenergic type (25%) and adrenergic type (8%) were rare. Interestingly, we did not observe catecholamine hypersecretion in 8% cases patients despite the subsequent verification of PCCs. Perhaps they had dopamine type of secretion which is currently not available in routine clinical practice. We could not find any obvious correlation between hypertension course and biochemical catecholamine profile. According to CT data of PCCs, the size varied from 1.5 cm to 20 cm (median 4.75), native density - from +9HU to +96HU (median +39HU). Lesion’s size was >4 cm in most of the patients (75%), however, CT-density <+10HU was a more accurate marker of pheochromocytoma.

Conclusion: In our cohort of patients, BP grade III (ESH/ESC 2018) predominated regardless of the type of catecholamine secretion. We could not find any obvious correlation between hypertension course and biochemical catecholamine profile. The absence of catecholamine hypersecretion does not exclude the presence of pheochromocytoma in patients with arterial hypertension and an adrenal tumor. Pheochromocytoma should be considered in adrenal lesions of high native CT-density.