J Korean Endocr Soc.  2009 Sep;24(3):189-194. 10.3803/jkes.2009.24.3.189.

A Case of Improved Diabetes Mellitus After Removal of Nonfunctioning Adrenal Incidentaloma Diagnosed as Pheochromocytoma

• Park SK
• Kim DS
• Roh MO
• Song MS
• Jung CH
• Jung JH
• Park HK
• Kim YJ
• Mok JO
• Kim SJ
• Kim CH
• Kim DW
• Byun DW
• Suh KI
• Yoo MH

• KMID: 2178181
• DOI: http://doi.org/10.3803/jkes.2009.24.3.189

Abstract

Pheochromocytoma not only decreases insulin secretion but also increases insulin resistance. One third of patients with pheochromocytoma have diabetes mellitus and their clinical prognosis showed improvement after surgery. Until now, those patients whose prognosis for diabetes mellitus improved after the operation of pheochromocytoma had typical characteristics such as hypertension, palpitation, headache and elevated hormones such as Vanillylmandelic acid, metanephrine, epinephrine and norepinephrine. We present the case of a 75-year-old woman with asymptomatic adrenal incidentaloma identified as pheochromocytoma which exhibited normal biochemical test results, and after removal of the abdominal mass, her severe hyperglycemia improved.

Keyword

diabetes mellitus; nonfunctioning incidentaloma; pheochromocytoma

MeSH Terms

Adrenal Gland Neoplasms
Aged
Diabetes Mellitus
Epinephrine
Female
Headache
Humans
Hyperglycemia
Hypertension
Insulin
Insulin Resistance
Metanephrine
Norepinephrine
Pheochromocytoma
Prognosis
Vanilmandelic Acid
Adrenal Gland Neoplasms
Epinephrine
Insulin
Metanephrine
Norepinephrine
Vanilmandelic Acid

Figure

• 

  Fig. 1 Enhanced abdomen CT. A. Precontrast axial CT scan shows 4.7 × 4 cm sized well defined heterogeneous low density mass in right adrenal gland (arrow). B. In arterial phase, the mass is well enhanced and has central necrosis (arrow).

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  Fig. 2 Histology findings. A. Cross section of the tumor shows a markedly variegated appearance with focal cystic change and hemorrhage. The tumor is encapsulated. B. On lower magnification, the tumor shows a solid growth pattern with a rich vascular network (×12.5, H&E stain). C. The tumor shows a small nesting pattern of growth with a 'zellballen' appearance (×400, H&E stain). D. Immunohistochemical staining of the tumor cells reveal diffuse and strong positivity for chromogranin (×200).

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