Adrenal Pheochromocytoma Incidentally Discovered in a Patient With Parkinsonism

Abstract

To evaluate the diagnostic route of pheochromocytoma (PHEO) in a patient under dopaminergic treatment.A 70-year-old man with Parkinsonism and under treatment with levodopa and carbidopa came to our observation for evaluation of arterial hypertension and right adrenal mass discovered incidentally.To evaluate adrenal hormone levels we performed a dexamethasone suppression test, plasma aldosterone levels and 24-hr urinary metanephrine, which revealed elevated levels of catecholamines metabolities. 123-I-metaiodobenzylguanidine SPECT scintiscan revealed raised activity within the right adrenal gland concordant with the mass. The diagnosis of PHEO was posed and an elective laparoscopic adrenalectomy was performed; histopathological examination confirmed the PHEO diagnosis.Recently the coexistence of PHEO and Parkinsonism is a very rare association of diseases, with only 3 cases reported in literature. In this article, another case is reported and diagnostic procedures are discussed.

A Rare Coexistence of Pheochromocytoma and Parkinson's Disease With Diagnostic Challenges

“…The enhancement pattern on our CT scans suggested an adrenal cortical tumor rather than a medullary tumor, whereas chemical shift MRI suggested the presence of a medullary tumor. The robust uptake of 123 I-MIBG was of greatest value among the imaging modalities in our case, as was true for the other four cases reported previously ( 4 - 7 ). Although fortunately the 123 I-MIBG uptake was also robust and convincing in our case as well, it would be more challenging to discriminate pheochromocytoma from pseudopheochromocytoma without obtaining convincing evidence through those imaging modalities.…”

“…In addition, the coexistence of these two diseases is very rare, and to date, only four cases have been reported. Therefore, these cases might offer a unique opportunity to gain insights into the pathological underpinnings of both diseases ( 4 - 7 ).…”