Kosin Med J.  2018 Dec;33(2):215-222. 10.7180/kmj.2018.33.2.215.

Adrenal incidentaloma: a case of asymptomatic pheochromocytoma

• Park SY
• Rim JC
• Cho HC
• Lee YC
• Kim JA
• Choi SR

• KMID: 2430737
• DOI: http://doi.org/10.7180/kmj.2018.33.2.215

Abstract

An incidentaloma is a tumor found incidentally without clinical symptoms or suspicion; the lesion may be adrenal, pituitary, or thyroidal. We report the case of an asymptomatic individual with preoperatively undiagnosed pheochromocytoma (size: 4.86 cm) that was revealed using elective nonadrenal surgical procedures. The patient demonstrated peri- and post-operative hypertensive crisis and tachycardia. Three days after the dramatic onset of symptoms, the patient expired due to pulmonary edema, multiple organ failure, and terminal sepsis, despite administration of extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation. A left medial kidney mass obtained at autopsy confirmed pheochromocytoma.

Keyword

Adrenal incidentaloma; Extracorporeal membrane oxygenation (ECMO); Hypertensive crisis; Pheochromocytoma; Pulmonary edema

MeSH Terms

Autopsy
Cardiopulmonary Resuscitation
Humans
Kidney
Membranes
Multiple Organ Failure
Pheochromocytoma*
Pulmonary Edema
Sepsis
Tachycardia
Thyroid Gland

Figure

• 

  Fig. 1 Upper abdominal ultrasonography. At the preoperative evaluation, 4.86 cm round solid mass in the left abdomen medial to the left kidney on upper abdomen was detected.

• 

  Fig. 2 The patient's initial ECG shows T wave

Reference

1. Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A. Management of adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab. 2009; 23:233–243.

2. Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004; 25:309–340.

3. Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009; 15:450–453.

4. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, et al. A survey on adrenal incidentaloma in Italy. Study group on adrenal tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000; 85:637–644.

5. Kasperlik-Zaluska AA, Roslonowska E, Slowinska-Srzednicka J, Otto M, Cichocki A, Cwikla J, et al. 1,111 patients with adrenal incidentalomas observed at a single endocrinological center: incidence of chromaffin tumors. Ann N Y Acad Sci. 2006; 1073:38–46.

6. O'Riordan JA. Pheochromocytomas and anesthesia. Int Anesthesiol Clin. 1997; 35:99–127.

7. Grogan RH, Mitmaker E, Vriens MR, Harari A, Gosnell JE, Shen WT, et al. Adrenal incidentaloma: does an adequate workup rule out surprises? Surgery. 2010; 148:392–397.

8. Veglio F, Morello F, Morra Di Cella S, Del Colle S, Rabbia F, Mulatero P. Recent advances in diagnosis and treatment of pheochromocytoma. Minerva Med. 2003; 94:267–271.

9. Lenz T, Gossmann J, Schulte KL, Salewski L, Geiger H. Diagnosis of pheochromocytoma. Clin Lab. 2002; 48:5–18.

10. Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma: Review of a 50-year autopsy series. Mayo Clin Proc. 1981; 56:354–360.

11. Siddik-Sayyid SM, Dabbous AS, Shaaban JA, Daaboul DG, Baraka AS. Catastrophic cardiac hypokinesis and multiple-organ failure after surgery in a patient with an undiagnosed pheochromocytoma: emergency excision of the tumor. J Cardiothorac Vasc Anesth. 2007; 21:863–866.

12. de Miguel V, Arias A, Paissan A, de Arenaza DP, Pietrani M, Jurado A, et al. Catecholamine-induced myocarditis in pheochromocytoma. Circulation. 2014; 129:1348–1349.

13. Bos JC, Toorians AW, van Mourik JC, van Schijndel RJ. Emergency resection of an extraadrenal phaeochromocytoma: wrong or right? A case report and a review of literature. Neth J Med. 2003; 61:258–265.

14. May EE, Beal AL, Beilman GJ. Traumatic hemorrhage of occult pheochromocytoma: a case report and review of the literature. Am Surg. 2000; 66:720–724.