Isolated Adrenal Mass in Patients with a History of Cancer: Remember Pheochromocytoma
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- Adler, J.T., Mack, E. & Chen, H. Ann Surg Oncol (2007) 14: 2358. doi:10.1245/s10434-007-9426-4
In a patient with a history of cancer, an isolated adrenal mass is usually thought to be a metastasis. Although a biochemical work-up to rule out pheochromocytoma is recommended, some question its practicality. This study was undertaken to determine the incidence of functional adrenal lesions in patients with a history of cancer and examine predictive factors for the type of lesion.
At a single institution, 33 patients with an isolated adrenal mass and a history of cancer underwent surgical treatment. Patients’ records were retrospectively analyzed for type of adrenal lesion and other diagnostic parameters.
There were 20 males and 13 females with a mean age of 58±2 years. Of these, 20 (61%) had adrenal metastases, 8 (24%) had pheochromocytomas, and 5 (15%) had adrenal adenomas. Usual diagnostic criteria, including presenting symptoms, primary tumor, and other demographic characteristics, did not consistently predict the pathology of the lesion.
Nearly 1 in 4 resected adrenal masses in patients with a history of cancer were pheochromocytomas. The high incidence of pheochromocytoma in this series supports a thorough work-up, irrespective of previous cancer. Therefore, remember one thing in patients with an isolated adrenal mass and a history of cancer: pheochromocytoma.