Endocrine Abstracts

Introduction: Pheochromocytoma is a catecholamine-secreting neuroendocrine tumor arising from the chromaffin cells of the adrenal medulla. It is rare and considered benign, but can be life-threatening in the event of catecholaminergic discharge. Tumors differ in genotype, mechanism of tumorigenesis and type of secretion. On imaging, it is often characterized by central intra-tumor necrosis; there is very little data in the literature on the genesis and pathophysiological role of the latter. As a result, necrosis is never measured at the time of diagnosis. In this study, we therefore wanted to investigate potential correlations between the extent of intra-tumor necrosis and the various hormonal secretions in pheochromocytomas.

Methods: We retrospectively identified all major patients operated on at Amiens University Hospital between 2005 and 2022 for adrenal pheochromocytoma confirmed by pathological examination and for whom diagnostic imaging (CT or MRI) and hormone assays were found in the database. The volume of intra-tumor necrosis was measured manually by a specialist radiologist at Amiens University Hospital.

Results: The analysis of this study is based on a total of 49 patients included between 2005 and 2022, 25 of whom were allocated to the group with necrosis and 24 to the group without necrosis after radiological assessment of intra-tumour necrosis. The mean age at the time of adrenalectomy was 53.4 ± 15.2 years. MRI was preferred for the study of intra-tumour necrosis when it had been performed (9 patients). After multivariate analysis, there was a significant difference between the two subgroups in terms of tumour volume, female sex and intensity of urinary metanephrine secretion.

Conclusion: At present, our study appears to the only one to examine the clinico-biological impact of intra-tumoral necrosis in pheochromocytomas. Significant factors have emerged which may guide clinical practice, particularly with regard to the role of MRI in the choice of diagnostic imaging.

Key-words: Pheochromocytoma, intra-tumour necrosis, metanephrines, clusters 1 and 2.