Skip to main content

Advertisement

Log in

Adrenal pheochromocytoma: is it all or the tip of the iceberg?

  • Review
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Adrenal pheochromocytoma is not always a simple retroperitoneal tumor but may be part of a more complicated condition. It often has a spectrum of complex and variable imaging features, may present as a collision tumor and composite tumor, and is associated with a variety of clinical syndromes. A comprehensive understanding of the clinical, pathological, and variable imaging manifestations of pheochromocytoma can help radiologists make an accurate diagnosis. This article reviews various special imaging features of pheochromocytoma and pheochromocytoma-related diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Plouin PF, Amar L, Dekkers OM, Fassnacht M, Gimenez-Roqueplo AP, Lenders JW, et al. European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma. Eur J Endocrinol. 2016;174:G1–10.

    CAS  PubMed  Google Scholar 

  2. Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005;366:665–75.

    PubMed  Google Scholar 

  3. Turchini J, Cheung VKY, Tischler AS, De Krijger RR, Gill AJ. Pathology and genetics of phaeochromocytoma and paraganglioma. Histopathology. 2018;72:97–105.

    PubMed  Google Scholar 

  4. Lam AK. Update on adrenal tumours in 2017 World Health Organization (WHO) of endocrine tumours. Endocr Pathol. 2017;28:213–27.

    PubMed  Google Scholar 

  5. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175:G1-g34.

    CAS  PubMed  Google Scholar 

  6. Nölting S, Bechmann N, Taieb D, Beuschlein F, Fassnacht M, Kroiss M, Eisenhofer G, Grossman A, Pacak K. Personalized management of pheochromocytoma and paraganglioma. Endocr Rev. 2021. https://doi.org/10.1210/endrev/bnab019.

    Article  PubMed  Google Scholar 

  7. Farrugia FA, Charalampopoulos A. Pheochromocytoma. Endocr Regul. 2019;53:191–212.

    PubMed  Google Scholar 

  8. Chen H, Sippel RS, O’Dorisio MS, Vinik AI, Lloyd RV, Pacak K, et al. The North American Neuroendocrine Tumor Society consensus guideline for the diagnosis and management of neuroendocrine tumors: pheochromocytoma, paraganglioma, and medullary thyroid cancer. Pancreas. 2010;39:775–83.

    PubMed  PubMed Central  Google Scholar 

  9. Graham JB. Pheochromocytoma and hypertension; an analysis of 207 cases. Int Abstr Surg. 1951;92:105–21.

    CAS  PubMed  Google Scholar 

  10. Elder EE, Elder G, Larsson C. Pheochromocytoma and functional paraganglioma syndrome: no longer the 10% tumor. J Surg Oncol. 2005;89:193–201.

    PubMed  Google Scholar 

  11. Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Ali 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;85:637–44.

    CAS  PubMed  Google Scholar 

  12. Falhammar H, Kjellman M, Calissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018;7:186–92.

    CAS  PubMed  Google Scholar 

  13. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99:1915–42.

    CAS  PubMed  Google Scholar 

  14. Cheung VKY, Gill AJ, Chou A. Old, new, and emerging immunohistochemical markers in pheochromocytoma and paraganglioma. Endocr Pathol. 2018;29:169–75.

    PubMed  Google Scholar 

  15. Zhikrivetskaya SO, Snezhkina AV, Zaretsky AR, Alekseev BY, Pokrovsky AV, Golovyuk AL, et al. Molecular markers of paragangliomas/pheochromocytomas. Oncotarget. 2017;8:25756–82.

    PubMed  PubMed Central  Google Scholar 

  16. Dahia PL. Pheochromocytoma and paraganglioma pathogenesis: learning from genetic heterogeneity. Nat Rev Cancer. 2014;14:108–19.

    CAS  PubMed  Google Scholar 

  17. European Society of Urogenital Radiology. ESUR guidelines on contrast agents. version 10.0. 2018. https://www.esur.org/fileadmin/content/2019/ESUR_Guidelines_10.0_Final_Version.pdf. Accessed 2 Sept 2021.

  18. American Committee on Drugs and Contrast Media. American College of Radiology. ACR manual on contrast media. version 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Accessed 02 Sept 2021.

  19. Nakano S, Tsushima Y, Taketomi-Takahashi A, Higuchi T, Amanuma M, Oriuchi N, et al. Hypertensive crisis due to contrast-enhanced computed tomography in a patient with malignant pheochromocytoma. Jpn J Radiol. 2011;29:449–51.

    PubMed  Google Scholar 

  20. Mukherjee JJ, Peppercorn PD, Reznek RH, Patel V, Kaltsas G, Besser M, et al. Pheochromocytoma: effect of nonionic contrast medium in CT on circulating catecholamine levels. Radiology. 1997;202:227–31.

    PubMed  Google Scholar 

  21. Bessell-Browne R, O’Malley ME. CT of pheochromocytoma and paraganglioma: risk of adverse events with i.v. administration of nonionic contrast material. AJR Am J Roentgenol. 2007;188:970–4.

    PubMed  Google Scholar 

  22. Eisenhofer G, Rivers G, Rosas AL, Quezado Z, Manger WM, Pacak K. Adverse drug reactions in patients with phaeochromocytoma: incidence, prevention and management. Drug Saf. 2007;30:1031–62.

    CAS  PubMed  Google Scholar 

  23. Taieb D, Hicks RJ, Hindie E, Guillet BA, Avram A, Ghedini P, et al. European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging. 2019;46:2112–37.

    PubMed  PubMed Central  Google Scholar 

  24. Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, et al. Imaging features of adrenal masses. Insights Imaging. 2019;10:1.

    PubMed  PubMed Central  Google Scholar 

  25. Leung K, Stamm M, Raja A, Low G. Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging. AJR Am J Roentgenol. 2013;200:370–8.

    PubMed  Google Scholar 

  26. Patel J, Davenport MS, Cohan RH, Caoili EM. Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma? AJR Am J Roentgenol. 2013;201:122–7.

    PubMed  Google Scholar 

  27. Park BK, Kim CK, Kwon GY, Kim JH. Re-evaluation of pheochromocytomas on delayed contrast-enhanced CT: washout enhancement and other imaging features. Eur Radiol. 2007;17:2804–9.

    PubMed  Google Scholar 

  28. Tanabe A, Naruse M. Recent advances in the management of pheochromocytoma and paraganglioma. Hypertens Res. 2020;43:1141–51.

    CAS  PubMed  Google Scholar 

  29. Sun F, Zhuo R, Ma W, Yang D, Su T, Ye L, et al. From clinic to mechanism: proteomics-based assessment of angiogenesis in adrenal pheochromocytoma. J Cell Physiol. 2019;234:22057–70.

    CAS  PubMed  Google Scholar 

  30. Fonseca EKUN, Ponte MPTR, Yamauchi FI, Baroni RH. The light bulb sign in pheochromocytoma. Abdom Radiol (N Y). 2017;42:2779.

    Google Scholar 

  31. Jacques AE, Sahdev A, Sandrasagara M, Goldstein R, Berney D, Rockall AG, et al. Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function. Eur Radiol. 2008;18:2885–92.

    PubMed  Google Scholar 

  32. Borhani AA, Hosseinzadeh K. Quantitative versus qualitative methods in evaluation of T2 signal intensity to improve accuracy in diagnosis of pheochromocytoma. AJR Am J Roentgenol. 2015;205:302–10.

    PubMed  Google Scholar 

  33. Magnaldi S, Mayerhoefer ME, Khameneh A, Schuetz M, Javor D, Mitterhauser M, et al. (18)F-DOPA PET/CT and MRI: description of 12 histologically-verified pheochromocytomas. Anticancer Res. 2014;34:791–5.

    PubMed  Google Scholar 

  34. Katabathina VS, Rajebi H, Chen M, Restrepo CS, Salman U, Vikram R, et al. Genetics and imaging of pheochromocytomas and paragangliomas: current update. Abdom Radiol (N Y). 2020;45:928–44.

    Google Scholar 

  35. Patel HV, Srivastava A, Becker MD, Beninato T, Laird AM, Singer EA. From diagnosis to therapy-PET imaging for pheochromocytomas and paragangliomas. Curr Urol Rep. 2021;22:2.

    PubMed  Google Scholar 

  36. Martucci VL, Pacak K. Pheochromocytoma and paraganglioma: diagnosis, genetics, management, and treatment. Curr Probl Cancer. 2014;38:7–41.

    PubMed  PubMed Central  Google Scholar 

  37. Carrasquillo JA, Chen CC, Jha A, Ling A, Lin FI, Pryma DA, et al. Imaging of pheochromocytoma and paraganglioma. J Nucl Med. 2021;62:1033–42.

    CAS  PubMed  Google Scholar 

  38. Taïeb D, Pacak K. Genetic determinants of pheochromocytoma and paraganglioma imaging phenotypes. J Nucl Med. 2020;61:643–5.

    PubMed  PubMed Central  Google Scholar 

  39. Timmers HJ, Chen CC, Carrasquillo JA, Whatley M, Ling A, Eisenhofer G, et al. Staging and functional characterization of pheochromocytoma and paraganglioma by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography. J Natl Cancer Inst. 2012;104:700–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012;36:75–82.

    PubMed  Google Scholar 

  41. Chakraborty PP, Patra S, Biswas SN, Santra G. Pure cystic adrenal space-occupying lesion: always rule out cystic pheochromocytoma. BMJ Case Rep. 2016;2016:bcr2016216337.

    PubMed  PubMed Central  Google Scholar 

  42. Corwin MT, Mitchell AS, Wilson M, Campbell MJ, Fananapazir G, Loehfelm TW. Accuracy of focal cystic appearance within adrenal nodules on contrast-enhanced CT to distinguish pheochromocytoma and malignant adrenal tumors from adenomas. Abdom Radiol (N Y). 2021;46:2683–9.

    Google Scholar 

  43. Erem C, Kocak M, Onder Ersoz H, Ersoz S, Yucel Y. Epinephrine-secreting cystic pheochromocytoma presenting with an incidental adrenal mass: a case report and a review of the literature. Endocrine. 2005;28:225–30.

    CAS  PubMed  Google Scholar 

  44. Chen CT, Chu HC. Calcific malignant pheochromocytoma. QJM. 2014;107:577–8.

    PubMed  Google Scholar 

  45. Ramsay JA, Asa SL, van Nostrand AWP, Hassaram ST, de Harven EP. Lipid degeneration in pheochromocytomas mimicking adrenal cortical tumors. Am J Surg Pathol. 1987;11:480–6.

    CAS  PubMed  Google Scholar 

  46. Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT, Pitman MB, Harisinghani M, et al. Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol. 2003;181:1663–8.

    PubMed  Google Scholar 

  47. Stone WZ, Wymer DC, Canales BK. Fluorodeoxyglucose-positron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer: review and diagnostic algorithm. J Endourol. 2014;28:104–11.

    PubMed  PubMed Central  Google Scholar 

  48. Raja A, Leung K, Stamm M, Girgis S, Low G. Multimodality imaging findings of pheochromocytoma with associated clinical and biochemical features in 53 patients with histologically confirmed tumors. AJR Am J Roentgenol. 2013;201:825–33.

    PubMed  Google Scholar 

  49. Puar T, Van Berkel A, Gotthardt M, Havekes B, Hermus ARMM, Lenders JWM, et al. Genotype-dependent brown adipose tissue activation in patients with pheochromocytoma and paraganglioma. J Clin Endocrinol Metab. 2016;101:224–32.

    CAS  PubMed  Google Scholar 

  50. Roman-Gonzalez A, Jimenez C. Malignant pheochromocytoma-paraganglioma: pathogenesis, TNM staging, and current clinical trials. Curr Opin Endocrinol Diabetes Obes. 2017;24:174–83.

    PubMed  Google Scholar 

  51. Martins D, Rodrigues D, Melo M, Carrilho F. Laparoscopic adrenalectomy as an effective approach to massive bilateral pheochromocytomas. BMJ Case Rep. 2017;2017:bcr2017221009.

    PubMed Central  Google Scholar 

  52. Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab. 2005;90:2110–6.

    CAS  PubMed  Google Scholar 

  53. Li ML, Fitzgerald PA, Price DC, Norton JA. Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery. 2001;130:1072–7.

    CAS  PubMed  Google Scholar 

  54. Sivula A. Recurrence of benign phaeochromocytoma by intraoperative implantation. Acta Chir Scand. 1974;140:334–9.

    CAS  PubMed  Google Scholar 

  55. Kittah NE, Gruber LM, Bancos I, Hamidi O, Tamhane S, Iñiguez-Ariza N, et al. Bilateral pheochromocytoma: clinical characteristics, treatment and longitudinal follow-up. Clin Endocrinol (Oxf). 2020;93:288–95.

    CAS  Google Scholar 

  56. Thompson LDR, Gill AJ, Asa SL, Clifton-Bligh RJ, de Krijger RR, Kimura N, et al. Data set for the reporting of pheochromocytoma and paraganglioma: explanations and recommendations of the guidelines from the International Collaboration on Cancer Reporting. Hum Pathol. 2021;110:83–97.

    CAS  PubMed  Google Scholar 

  57. Remer EM, Motta-Ramirez GA, Shepardson LB, Hamrahian AH, Herts BR. CT histogram analysis in pathologically proven adrenal masses. AJR Am J Roentgenol. 2006;187:191–6.

    PubMed  Google Scholar 

  58. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Pheochromocytoma as a frequent false-positive in adrenal washout CT: a systematic review and meta-analysis. Eur Radiol. 2018;28:1027–36.

    PubMed  Google Scholar 

  59. Miller FH, Wang Y, McCarthy RJ, Yaghmai V, Merrick L, Larson A, et al. Utility of diffusion-weighted MRI in characterization of adrenal lesions. AJR Am J Roentgenol. 2010;194:W179–85.

    PubMed  Google Scholar 

  60. Lin MF, Chang-Sen LQ, Heiken JP, Pilgram TK, Bae KT. Histogram analysis for characterization of indeterminate adrenal nodules on noncontrast CT. Abdom Imaging. 2015;40:1666–74.

    PubMed  Google Scholar 

  61. Zhang GM, Shi B, Sun H, Jin ZY, Xue HD. Differentiating pheochromocytoma from lipid-poor adrenocortical adenoma by CT texture analysis: feasibility study. Abdom Radiol (N Y). 2017;42:2305–13.

    Google Scholar 

  62. Takano A, Oriuchi N, Tsushima Y, Taketomi-Takahashi A, Nakajima T, Arisaka Y, et al. Detection of metastatic lesions from malignant pheochromocytoma and paraganglioma with diffusion-weighted magnetic resonance imaging: comparison with 18F-FDG positron emission tomography and 123I-MIBG scintigraphy. Ann Nucl Med. 2008;22:395–401.

    PubMed  Google Scholar 

  63. Tsushima Y, Takahashi-Taketomi A, Endo K. Diagnostic utility of diffusion-weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors. J Magn Reson Imaging. 2009;29:112–7.

    PubMed  Google Scholar 

  64. Umanodan T, Fukukura Y, Kumagae Y, Shindo T, Nakajo M, Takumi K, et al. ADC histogram analysis for adrenal tumor histogram analysis of apparent diffusion coefficient in differentiating adrenal adenoma from pheochromocytoma. J Magn Reson Imaging. 2017;45:1195–203.

    PubMed  Google Scholar 

  65. Kim S, Salibi N, Hardie AD, Xu J, Lim RP, Lee VS, et al. Characterization of adrenal pheochromocytoma using respiratory-triggered proton MR spectroscopy: initial experience. AJR Am J Roentgenol. 2009;192:450–4.

    PubMed  Google Scholar 

  66. Lussey-Lepoutre C, Bellucci A, Burnichon N, Amar L, Buffet A, Drossart T, et al. Succinate detection using in vivo (1)H-MR spectroscopy identifies germline and somatic SDHx mutations in paragangliomas. Eur J Nucl Med Mol Imaging. 2020;47:1510–7.

    CAS  PubMed  Google Scholar 

  67. Acosta AM, Al Rasheed MRH, Pins MR, Borgen KR, Panchal D, Rogozinska M, et al. The role of next-generation sequencing in the differential diagnosis of composite neoplasms. Hum Pathol. 2018;81:78–88.

    CAS  PubMed  Google Scholar 

  68. Peng Y, Lin J, Guan J, Chen L, Zhang X, Li S, et al. Ovarian collision tumors: imaging findings, pathological characteristics, diagnosis, and differential diagnosis. Abdom Radiol (N Y). 2018;43:2156–68.

    Google Scholar 

  69. Khan AN, Solomon SS, Childress RD. Composite pheochromocytoma-ganglioneuroma: a rare experiment of nature. Endocr Pract. 2010;16:291–9.

    PubMed  Google Scholar 

  70. Gupta S, Zhang J, Erickson LA. Composite pheochromocytoma/paragangliomas–ganglioneuroma: a clinicopathologic study of eight cases with analysis of succinate dehydrogenase. Endocr Pathol. 2017;28:269–75.

    CAS  PubMed  Google Scholar 

  71. Shida Y, Igawa T, Abe K, Hakariya T, Takehara K, Onita T, et al. Composite pheochromocytoma of the adrenal gland: a case series. BMC Res Notes. 2015;8:257.

    PubMed  PubMed Central  Google Scholar 

  72. Fujiwara T, Kawamura M, Sasou S, Hiramori K. Results of surgery for a compound adrenal tumor consisting of pheochromocytoma and ganglioneuroblastoma in an adult: 5-year follow-up. Intern Med. 2000;39:58–62.

    CAS  PubMed  Google Scholar 

  73. Shawa H, Elsayes KM, Javadi S, Sircar K, Jimenez C, Habra MA. Clinical and radiologic features of pheochromocytoma/ganglioneuroma composite tumors: a case series with comparative analysis. Endocr Pract. 2014;20:864–9.

    PubMed  Google Scholar 

  74. Sung CT, Shetty A, Menias CO, Houshyar R, Chatterjee S, Lee TK, et al. Collision and composite tumors; radiologic and pathologic correlation. Abdom Radiol (N Y). 2017;42:2909–26.

    Google Scholar 

  75. Katabathina VS, Flaherty E, Kaza R, Ojili V, Chintapalli KN, Prasad SR. Adrenal collision tumors and their mimics: multimodality imaging findings. Cancer Imaging. 2013;13:602–10.

    PubMed  PubMed Central  Google Scholar 

  76. Zhang CX, Tian Y. Adrenal collision tumor composed of adrenocortical adenoma and pheochromocytoma. Chin Med J (Engl). 2018;131:374–5.

    Google Scholar 

  77. Sakamoto N, Tojo K, Saito T, Fujimoto K, Isaka T, Tajima N, et al. Coexistence of aldosterone-producing adrenocortical adenoma and pheochromocytoma in an ipsilateral adrenal gland. Endocr J. 2009;56:213–9.

    CAS  PubMed  Google Scholar 

  78. Piotrowski Z, Tomaszewski JJ, Hartman AL, Edwards K, Uzzo RG. Renal cell carcinoma and an incidental adrenal lesion: adrenal collision tumors. Urology. 2015;85:e17–8.

    PubMed  Google Scholar 

  79. Muth A, Crona J, Gimm O, Elmgren A, Filipsson K, Stenmark Askmalm M, et al. Genetic testing and surveillance guidelines in hereditary pheochromocytoma and paraganglioma. J Intern Med. 2019;285:187–204.

    CAS  PubMed  Google Scholar 

  80. Ganeshan D, Menias CO, Pickhardt PJ, Sandrasegaran K, Lubner MG, Ramalingam P, et al. Tumors in von Hippel–Lindau syndrome: from head to toe-comprehensive state-of-the-art review. Radiographics. 2018;38:849–66.

    PubMed  Google Scholar 

  81. Grajo JR, Paspulati RM, Sahani DV, Kambadakone A. Multiple endocrine neoplasia syndromes: a comprehensive imaging review. Radiol Clin N Am. 2016;54:441–51.

    PubMed  Google Scholar 

  82. Sonavane AD, Amarapurkar DN, Amarapurkar AD. Polycystic pancreas. ACG Case Rep J. 2016;3:199–201.

    PubMed  PubMed Central  Google Scholar 

  83. Baghdadi A, Ghadimi M, Mirpour S, Hazhirkarzar B, Motaghi M, Pawlik TM, et al. Imaging neuroendocrine tumors: characterizing the spectrum of radiographic findings. Surg Oncol. 2021;37:101529.

    PubMed  Google Scholar 

  84. Park BK. Renal angiomyolipoma: radiologic classification and imaging features according to the amount of fat. AJR Am J Roentgenol. 2017;209:826–35.

    PubMed  Google Scholar 

  85. Hu X, Guan J, Wang Y, Shi S, Song C, Li ZP, et al. A narrative review of multiple endocrine neoplasia syndromes: genetics, clinical features, imaging findings, and diagnosis. Ann Transl Med. 2021;9:944.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Peczkowska M, Januszewicz A. Multiple endocrine neoplasia type 2. Fam Cancer. 2005;4:25–36.

    PubMed  Google Scholar 

  87. Kim HJ, Kim AY, Lee CW, Yu CS, Kim JS, Kim PN, et al. Hirschsprung disease and hypoganglionosis in adults: radiologic findings and differentiation. Radiology. 2008;247:428–34.

    PubMed  Google Scholar 

  88. Badrinath M, Mandru R, Lowe D, Manocha D, Achufusi T. Isolated intestinal ganglioneuroma mimicking small bowel Crohn’s disease. ACG Case Rep J. 2019;6:e00114.

    PubMed  PubMed Central  Google Scholar 

  89. Santos P, Pimenta T, Taveira-Gomes A. Hereditary pheochromocytoma. Intern J Surg Pathol. 2014;22:393–400.

    Google Scholar 

  90. Withey SJ, Perrio S, Christodoulou D, Izatt L, Carroll P, Velusamy A, et al. Imaging features of succinate dehydrogenase-deficient pheochromocytoma–paraganglioma syndromes. Radiographics. 2019;39:1393–410.

    PubMed  Google Scholar 

  91. Iacobone M, Citton M, Viel G, Schiavone D, Torresan F. Surgical approaches in hereditary endocrine tumors. Updates Surg. 2017;69:181–91.

    PubMed  Google Scholar 

  92. Else T, Greenberg S, Fishbein L. Hereditary paraganglioma-pheochromocytoma syndromes. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mirzaa G, Amemiya A, editors. GeneReviews® [Internet]. Seattle, WA: University of Washington Seattle; 2018.

    Google Scholar 

  93. Hirbe AC, Gutmann DH. Neurofibromatosis type 1: a multidisciplinary approach to care. Lancet Neurol. 2014;13:834–43.

    PubMed  Google Scholar 

  94. Garrouche N, Ben Abdallah A, Arifa N, Hasni I, Ben Cheikh Y, Ben Farhat W, et al. Spectrum of gastrointestinal lesions of neurofibromatosis type 1: a pictorial review. Insights Imaging. 2018;9:661–71.

    PubMed  PubMed Central  Google Scholar 

  95. Shanbhogue AK, Fasih N, Macdonald DB, Sheikh AM, Menias CO, Prasad SR. Uncommon primary pelvic retroperitoneal masses in adults: a pattern-based imaging approach. Radiographics. 2012;32:795–817.

    PubMed  Google Scholar 

  96. Képénékian L, Mognetti T, Lifante JC, Giraudet AL, Houzard C, Pinson S, et al. Interest of systematic screening of Pheochromocytoma in patients with neurofibromatosis type 1. Eur J Endocrinol. 2016;175:335–44.

    PubMed  Google Scholar 

  97. Stewart DR, Korf BR, Nathanson KL, Stevenson DA, Yohay K. Care of adults with neurofibromatosis type 1: a clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2018;20:671–82.

    PubMed  Google Scholar 

  98. Taieb D, Jha A, Treglia G, Pacak K. Molecular imaging and radionuclide therapy of pheochromocytoma and paraganglioma in the era of genomic characterization of disease subgroups. Endocr Relat Cancer. 2019;26:R627–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  99. Alrezk R, Suarez A, Tena I, Pacak K. Update of pheochromocytoma syndromes: genetics, biochemical evaluation, and imaging. Front Endocrinol (Lausanne). 2018;9:515.

    PubMed Central  Google Scholar 

  100. Favier J, Amar L, Gimenez-Roqueplo AP. Paraganglioma and phaeochromocytoma: from genetics to personalized medicine. Nat Rev Endocrinol. 2015;11:101–11.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr. Lili CHEN, Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, for advice on pathological images. We thank Dr. Yuanxian YANG, Department of obstetrics and gynecology, the Eighth Hospital of Wuhan, for her encouragement that let us never give up.

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Contributions

KW and GT contributed equally to this work. They are co-first authors. All authors contributed to the study conception and design. The first draft of the manuscript was written by KW and GT. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jian Guan.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical statement

The manuscript is a review article and has no studies with human participants or animals performed by any of the authors. Approval was granted by the Ethics Committee of The First Affiliated Hospital, Sun Yat-Sen University.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, K., Tang, G., Peng, Y. et al. Adrenal pheochromocytoma: is it all or the tip of the iceberg?. Jpn J Radiol 40, 120–134 (2022). https://doi.org/10.1007/s11604-021-01199-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-021-01199-1

Keywords

Navigation