A patient with a large recurrent pheochromocytoma demonstrating the pitfalls of diagnosis

Nat Rev Endocrinol. 2011 Sep 6;7(12):749-55. doi: 10.1038/nrendo.2011.132.

Abstract

Background: A 59-year-old man presented for a follow-up, 6 years after surgery for a large pheochromocytoma. He had suffered from diabetes mellitus, hypertension and abdominal pain in the right flank region. Previous postoperative follow-up did not reveal tumor recurrence.

Investigation: Measurement of plasma free metanephrine and normetanephrine by high-performance liquid chromatography and radioimmunoassay; 123I-metaiodobenzylguanidine (MIBG) scintigraphy; hybrid 123I-MIBG single-photon emission CT (SPECT)-CT; MRI; testing for plasma norepinephrine and epinephrine; intraoperative ultrasonography; histological staining for chromogranin A and synaptophysin; and postoperative 18F-dihydroxyphenylalanine (DOPA) PET scan.

Diagnosis: Recurrent pheochromocytoma.

Management: Laparotomy with tumor resection. Reduction of antihypertensive medications. Further follow-up by MRI, hybrid 123I-MIBG SPECT-CT and testing for plasma catecholamines and free metanephrines.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain
  • Adrenal Gland Neoplasms / diagnosis*
  • Adrenal Gland Neoplasms / drug therapy
  • Adrenal Gland Neoplasms / surgery
  • Antihypertensive Agents / administration & dosage
  • Chromogranin A / analysis
  • Diabetes Mellitus, Type 2 / complications
  • Epinephrine / blood
  • Epinephrine / urine
  • Humans
  • Hypertension / complications
  • Iodine Radioisotopes
  • Magnetic Resonance Imaging
  • Male
  • Metanephrine / blood
  • Metanephrine / urine
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / surgery
  • Norepinephrine / blood
  • Norepinephrine / urine
  • Normetanephrine / blood
  • Normetanephrine / urine
  • Pheochromocytoma / diagnosis*
  • Pheochromocytoma / drug therapy
  • Pheochromocytoma / surgery
  • Synaptophysin / analysis
  • Tomography, Emission-Computed, Single-Photon
  • Vena Cava, Inferior / pathology

Substances

  • Antihypertensive Agents
  • Chromogranin A
  • Iodine Radioisotopes
  • Synaptophysin
  • Normetanephrine
  • Metanephrine
  • Norepinephrine
  • Epinephrine