J Korean Endocr Soc.  2009 Jun;24(2):126-131. 10.3803/jkes.2009.24.2.126.

Graves' Disease Accompanied by Pheochromocytoma: Report of a Case

• Kim JH
• Lee SJ
• Shin JH
• You MR
• Jung JS
• Kim SY
• Bae HY

• KMID: 1468508
• DOI: http://doi.org/10.3803/jkes.2009.24.2.126

Abstract

We present here a rare case of Graves' disease accompanied by pheochromocytoma, and the patient showed normal urine and serum levels of catecholamines and their metabolites. A 45-year-old woman was referred to our hospital for the evaluation of a right adrenal incidentaloma that was detected by chest computed tomography. She had been diagnosed with Graves' disease 1 month previously. She had no symptoms of pheochromocytoma such as hypertension or a history of hypertension attack. Two consecutive 24-hour urine samples were sent to the lab for measurement of the catecholamines, and both samples showed normal levels of metanephrine and vanillylmandelic acid (VMA). After right adrenalectomy was performed, the final pathological diagnosis was adrenal pheochromocytoma. This case suggests that the onset of Graves' disease may be associated with excess catecholamine secreted by a pheochromocytoma. In addition, although the conventional method for detecting pheochromocytoma is to identify an increase of the urine catecholamines, physicians should be aware of the possibility of false negativity on this test.

Keyword

catecholamine; Graves' disease; pheochromocytoma

MeSH Terms

Adrenal Gland Neoplasms
Adrenalectomy
Catecholamines
Female
Graves Disease
Humans
Hypertension
Metanephrine
Middle Aged
Pheochromocytoma
Pyridines
Thiazoles
Thorax
Vanilmandelic Acid
Adrenal Gland Neoplasms
Catecholamines
Metanephrine
Pyridines
Thiazoles
Vanilmandelic Acid

Figure

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  Fig. 1 Chest computed tomography (CT) and Abdominal CT. A. Chest CT showed a 1.2 cm unenhanced SPN in the right upper lobe. B. Abdominal CT revealed a 4.8 × 3.6 cm heterogenously enhanced mass in the right adrenal gland.

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  Fig. 2 Gross appearance after right adrenalectomy. Resected adrenal gland showed encapsulated ovoid mass and diffuse areas of hemorrhages.

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  Fig. 3 Microscopic features of pheochromocytoma. Nests of tumor cells ("Zellballen") are separated by thin connective tissue stroma, containing abundant thin walled blood vessels. The tumor cells have oval nuclei and abundant granular cytoplasm. (A) H&E ×40 (B) H&E ×200.

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  Fig. 4 Immunohistochemistry stain of pheochromocytoma. There is positive for chromogranin (A) and S-100 protein (B).

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