Nonfunctioning Adrenal Pheochromocytoma Incidentally Discovered Associated with Renal Oncocytoma

Abstract

The patient was under treatment with irbesartan (150 mg once a day) plus hydrochlorothiazide (12.5 mg once a day) for arterial hypertension. He did not report any complaints of episodic headaches, palpitations, sweating, chest pain, or hematuria. On physical examination, the patient's heart rate was 68 beats per minute and his blood pressure (BP) was 140/ 80 mmHg without postural drop. His height and weight were 180 cm and 92 kg, respectively, with a body mass index of 28 kg/m 2 , and a waist circumference 110 cm. No cardiac murmurs or abdominal bruits were revealed. We performed ambulatory blood pressure monitoring (ABPM), which revealed a global mean BP of 129/75 mmHg with a lack of nocturnal fall in the BP (nondipping profile). The electrocardiogram was unremarkable, but an echocardiogram showed mild left ventricular concentric remodeling. Blood tests were normal except for the serum creatinine level (1.2 mg/dL; n.v. 0.50-0.90) and high serum acid uric (9.7 mg/dL; n.v. 2.40-5.70). A hormone investigation for the adrenal gland, including a low-dose dexamethasone suppression test and plasma cortisol values, was normal. Repeated 24h urinary metanephrines measurements were in the normal range, 150 and 234 μg/24h, respectively (normal value 0-350 μg/24h); and vanillylmandelic acid 1.8 and 2.7 μg/24h, respectively, (normal value 0-10, mg/24h) (Tab. I). Because of suspected renal and adrenal neoplasms, a surgical consult was requested and the patient simultaneously underwent an ipsilateral adrenalectomy and a radical nephrectomy. In particular, the surgical treatment was performed with a midline incision with a transperitoneal approach. The operative time was around 130 minutes and the approximate blood loss was 30 cc. The postoperative course was uneventful, and the patient was discharged from hospital and attended a regular follow-up.

Pelvic and Bladder Catecholamine-Producing Tumors: A Review of the Literature

“…It is necessary to pinpoint that, unfortunately, these determinations do not reach a 100% of sensitivity and specificity, and they could cause false negative results because catecholamines secretion might be sporadic or even undetectable, mainly in asymptomatic patients [86]. Our two cases well document the absence of detectable 24-h urinary metanephrines and VMA in several measurements, despite the histological confirm of PGL diagnosis.…”

Pelvic and Bladder Catecholamine-Producing Tumors A Review of the Literature

“…Furthermore, MIBG Scintigraphy has limited use in these cases because of sub-optimal sensitivity, especially in metastatic PGLs and those carrying succinate-dehydrogenase (SDH)x mutations. In particular, Brito et al had observed that functional imaging in pheochromocytoma had small additive value to morphological imaging such as CT or MR; further research should evaluate impact of functional imaging in specific subgroups such as metastatic or extra-adrenal PGLs [87].…”

Pelvic and Bladder Catecholamine-Producing Tumors A Review of the Literature

“…Our case reports, indeed, confirm the outcomes reported in PGLs and PHEOs literature (Figure 4). In more detail, according to Primary Aldosteronism Surgery Outcome (PASO) criteria [87], used for detection of primary aldosteronism cure after adrenalectomy, we performed a subanalysis to evaluate the effect of surgical treatment of PGLs in terms of clinical and biochemical remission. The group A included patients with clinical and biochemical remission; the group B only biochemical values normalization (e.g.…”