Case 214: Adrenal Pheochromocytoma with Perirenal Brown Fat Stimulation

Abstract

History A 61-year-old woman with well-controlled diabetes presented with a 10-year history of hypertension, stifling sensation, and flushing. Her body mass index was 19.1 kg/m(2) (normal range, 18.5-25.0 kg/m(2)). She was being followed up for mild hypercalcemia (calcium level, 10.8 mg/dL [2.7 mmol/L]) (normal range, 8.5-10.5 mg/dL [2.12-2.62 mmol/L]) by the endocrinologist (S.J.M.), who decided to perform a technetium 99m sestamibi ((99m)Tc MIBI) parathyroid scan. The test showed an abnormal tracer deposit in the region of the clavicle and sternum; thus, unenhanced thoracic computed tomography (CT) was performed. No mass was seen in the region of abnormality. In light of these findings, the patient underwent contrast material-enhanced (120 mL of iopromide, Ultravist 300; Schering, Berlin, Germany) thoracic abdominopelvic CT. There was no history of underlying malignancy, and the complete blood counts were normal. The axial and appendicular skeleton showed no sign of lesions.

Genotype-Dependent Brown Adipose Tissue Activation in Patients With Pheochromocytoma and Paraganglioma

“…In patients with PGLs, activated BAT tissue is often visualized (6,7), and it was present in up to 27% of patients when various functional imaging studies, including 18 F-FDG PET/CT, were combined (8). The recruitment of BAT appears to be dynamic, with case reports of patients with PGLs demonstrating BAT activation in association with increased systemic catecholamine levels, whereas normalization of catecholamines after surgery subsequently led to a significant reduction of BAT activation (9,10).…”

Role of the autonomic nervous system in activation of human brown adipose tissue: A review of the literature

“…The presence of BAT has also been confirmed in one case series and one case report, both of which took perinephric adipose tissue samples from patients with phaeochromocytoma and those with adrenocortical adenoma [48,49]. Also, causality has been even more strongly indicated by several case reports of patients with phaeochromocytoma before and after surgery.…”