Ann Surg Treat Res.  2024 Jan;106(1):38-44. 10.4174/astr.2024.106.1.38.

Silent pheochromocytoma in adrenal incidentaloma: unveiling clinical and radiological characteristics

• Kim BC
• Pak SJ
• Kwon D
• Cho JW
• Kim WW
• Lee Ym
• Park KJ
• Chung KW
• Sung TY

• KMID: 2550249
• DOI: http://doi.org/10.4174/astr.2024.106.1.38

Abstract

Purpose
Silent pheochromocytoma refers to tumors without signs and symptoms of catecholamine excess. This study aimed to clarify the clinical, radiological characteristics, and perioperative features of silent pheochromocytomas diagnosed after adrenalectomy for adrenal incidentaloma.
Methods
Medical records of patients who underwent adrenalectomy for adrenal incidentaloma and were subsequently diagnosed with silent pheochromocytoma between January 2000 and December 2020 were retrospectively reviewed for demographic, diagnostic, surgical, and pathological findings.
Results
Of the 130 patients who underwent adrenalectomy for incidentaloma, 8 (6.1%) were diagnosed with silent pheochromocytoma. Almost all patients had no hypertensive symptoms and their baseline hormonal levels remained within normal ranges. All patients exhibited tumor size >4 cm, precontrast Hounsfield unit >10, and absolute washout <60%. Intraoperative hypertensive events were noted in 2 patients (25.0%) in whom antiadrenergic medications were not administered. All patients in the intraoperative hypertensive event group exhibited atypical features on CT, whereas 83.3% of patients in the non-intraoperative hypertensive event group showed atypical features on CT imaging.
Conclusion
Silent pheochromocytomas share radiological traits with malignant adrenal tumors. Suspicious features on CT scans warrant surgical consideration for appropriate treatment. Administering alpha-blockers can enhance hemodynamic stability during adrenalectomy in suspected silent pheochromocytoma cases.

Keyword

Adrenalectomy; Adrenal incidentaloma; Computed tomography; Hypertensive; Pheochromocytoma

Figure

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  Fig. 1 (A) Precontrast image of the adrenal CT presenting the right adrenal tumor (arrow). (B) Postcontrast image of adrenal CT presenting an irregular shape and heterogeneous enhancement (arrow) of the same right adrenal tumor.

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