Usefulness of single photon emission computed tomography (SPECT)/computed tomography and radioguided surgery in a patient with recurrent pheochromocytoma

Uña-Gorospe, J.; Muñoz-Iglesias, J.; Sequera-Rahola, Marta De; Antón, L. M.

doi:10.4103/0972-3919.116801

Cited by 4 publications

(1 citation statement)

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“…Radioisotope-guided surgery is commonly used in certain surgical specialties such as sentinel lymph node mapping in melanoma and breast cancer, radioimmunoguided surgery in colon cancer, and localization of parathyroid adenoma (19). Radio-guided localization of pheochromocytoma using 123 I-MIBG scintigraphy and intraoperative gamma probe has been reported in a few cases (20)(21)(22); however, to our knowledge, this is the first case to describe its use in pheochromocytomatosis. A decision was made to use this technique in our patient due to the suspicion that there could be numerous small tumor nodules that could not be identified by the pre-operative CT and MIBG scans.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytomatosis Treated By Radio-Guided Surgery

Javid¹,

Callender²,

Baregamian³

et al. 2017

AACE Clinical Case Reports

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Objective: Pheochromocytomatosis is a rare cause of recurrent pheochromocytoma due to seeding of tumor cells at the time of adrenalectomy. The diagnosis can be difficult and a high degree of suspicion is required pre-operatively. We present the case of a 57-year-old woman with a long history of symptoms suggestive of recurrent pheochromocytoma that evaded diagnosis for many years. Methods: We describe the clinical course, diagnosis, and management. We also present a comprehensive review of the current literature. Results: Pheochromocytomatosis in our patient presented as multiple recurrent episodes of tachycardia and hypertension 15 years after left adrenalectomy for pheochromocytoma. Diagnosis was evaded until complete hormonal evaluation confirmed biochemical evidence of catecholamine overproduction. Imaging revealed two sites of recurrence. Management included alpha-blockade followed by radio-guided surgery using 123 I-labeled metaiodobenzylguanidine scintigraphy and a gamma probe. At surgery, pheochromocytomatosis involved the spleen, omentum, and adrenal bed. A complete en bloc resection was performed, allowing normalization of the patient's blood pressure and heart rate postoperatively. Review of the literature identified 4 similar cases. Radioguided surgery has been used in a few cases to localize pheochromocytoma, but has not been reported previously for intra-operative localization of pheochromocytomatosis. Conclusion: Our case highlights the importance of lifelong follow-up and thorough endocrine evaluation for patients with recurrent symptoms after initial surgical treatment for pheochromocytoma. It also describes the utility of radio-guided surgery in the treatment of pheochromocytomatosis. (AACE Clinical Case Rep. 2017;3:e170-e175

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Section: Discussionmentioning

confidence: 99%