Endocrine Abstracts

Pheochromocytomas are rare catecholamine-producing tumors that arise from chromaffin cells located in the adrenal medulla. They are usually benign, but approximately 10% of pheochromocytomas are malignant. The most common clinical features include Menard triad: headache, sweating and palpitations, and permanent or paroxysmal hypertension. Haematuria as a presenting feature of adrenal pheochromocytoma is rarely seen. We report a case of pheochromocytoma in a 61-year-old female patient who presented with haematuria, sporadic left-sided lumbar pressure with some diaphoresis, and well-regulated permanent hypertension. Due to the suspected left adrenal mass seen on the ultrasound, abdominal computed tomography (CT) was done and revealed a 70 mm large left adrenal gland mass. Subsequently, a left-sided adrenalectomy was performed in 2015. Pathohistological examination confirmed pheochromocytoma with an increased risk of malignant behavior. Annual follow-up in 2019. detected elevated urinary metanephrines and normetanephrin. CT scan confirmed 30x24 mm tumor recurrence in left kidney hilus and the patient was submitted to reoperation. Two years after – in 2021. slightly increased values of urinary normetanephrine were noticed although the patient didn’t have any symptoms related to excessive catecholamine level once again. Contrast-enhanced thorax CT scan of the abdomen didn’t show any suspected lesions but multiple 7 mm large solid lung nodules at bilateral lung basis were noticed. Further, thoracic CT set suspicion of lung metastases so following PET/CT as well as SPECT- CT – MIBG 131 confirmed the suspected metabolically active spread of malignant pheochromocytoma and the patient was referred to an oncologist. Clinical feature of pheochromocytoma are primarily associated with excessive catecholamine production with levels that are expected to be proportional to tumor size. In this case report we wanted to show patient who, except of haematuria as first symptom to be evaluated for, pheochromocytoma was clinicaly silent, as well as the reccurence of tumor or presence of (lung) metastases. Patient did not have any adrenergic symptoms before surgical removal as well as after reaccurance of tumor or lung metastases. Early diagnosis accompanied by lifelong anual follow-up is essential to enable early detection of recurrence and potential malignant complications and in our case report we wanted to emphasis the importance of urinary catecholamine metabolites measurment in follow-up of these patients.