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A Dangerous Liaison—Pheochromocytoma in Patients with Malignant Disease

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Abstract

Background

Adrenal masses in patients with known malignancy may be interpreted as metastasized disease, although a significant proportion of these tumors are of adrenal origin. Despite improved imaging techniques, it remains difficult to distinguish an adrenal metastasis from a pheochromocytoma or a lipid-poor adrenocortical adenoma.

Patients and methods

We report a case series of four patients with established or suspected malignant disease (melanoma, transitional cell carcinoma and prostate carcinoma, thyroid carcinoma, colorectal carcinoma) harboring an adrenal mass. None of these patients showed clinical symptoms indicative for a pheochromocytoma.

Results

Surgery unrelated to the adrenal lesion (n = 3) or biopsy of the adrenal mass (n = 1) was performed without prior endocrine work-up. Pronounced hemodynamic instability including hypertensive crisis was observed during surgery in all patients. In contrast, in the same patients preoperative α-blockade with phenoxybenzamine and an increased awareness of the potential risks led to improved hemodynamic stability following adrenalectomy for pheochromocytoma.

Conclusion

Our series is a strong reminder of the risks associated with surgery in patients harboring an unsuspected pheochromocytoma and underscores the need to exclude a pheochromocytoma in all patients with an adrenal mass and without a definitive diagnosis of the mass, especially when they are scheduled for surgery or adrenal biopsy. Otherwise, life-threatening hypertensive crisis can be precipitated even in the previously asymptomatic patient.

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References

  1. 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

    Article  PubMed  Google Scholar 

  2. Gillams A, Roberts CM, Shaw P, Spiro SG, Goldstraw P. The value of CT scanning and percutaneous fine needle aspiration of adrenal masses in biopsy-proven lung cancer. Clin Radiol 1992; 46:18–22

    Article  PubMed  CAS  Google Scholar 

  3. Fassnacht M, Kenn W, Allolio B. Adrenal tumors: How to establish malignancy? J Endocrinol Invest 2004; 27:387–399

    PubMed  CAS  Google Scholar 

  4. Platts JK, Drew PJ, Harvey JN. Death from phaeochromocytoma: lessons from a post-mortem survey. J R Coll Physicians Lond 1995; 29:299–306

    PubMed  CAS  Google Scholar 

  5. Primhak RA, Spicer RD, Variend S. Sudden death after minor abdominal trauma: An unusual presentation of phaeochromocytoma. Br Med J (Clin Res Ed) 1986; 292:95–96

    Article  CAS  Google Scholar 

  6. Ross NS, Aron DC. Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 1990; 323:1401–1405

    Article  PubMed  CAS  Google Scholar 

  7. Kievit J, Haak HR. Diagnosis and treatment of adrenal incidentaloma. A cost-effectiveness analysis. Endocrinol Metab Clin North Am 2000; 29:69–90, viii–ix

    Article  CAS  Google Scholar 

  8. Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med 2003; 138:424–429

    PubMed  Google Scholar 

  9. Lau J, Balk E, Rothberg M, et al. Management of clinically inapparent adrenal mass. Evid Rep Technol Assess (Summer) 2002:1–5

    Google Scholar 

  10. Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: Which test is best? JAMA 2002; 287:1427–1434

    Article  PubMed  CAS  Google Scholar 

  11. Guller U, Turek J, Eubanks S, Delong ER, Oertli D, Feldman JM. Detecting pheochromocytoma: defining the most sensitive test. Ann Surg 2006; 243:102–107

    Article  PubMed  Google Scholar 

  12. Van Der Horst-Schrivers AN, Jager PL, Boezen HM, Schouten JP, Kema IP, Links TP. Iodine-123 metaiodobenzylguanidine scintigraphy in localising phaeochromocytomas—experience and meta-analysis. Anticancer Res 2006; 26:1599–1604

    Google Scholar 

  13. Aron DC. The adrenal incidentaloma: Disease of modern technology and public health problem. Rev Endocr Metab Disord 2001; 2:335–342

    Article  PubMed  CAS  Google Scholar 

  14. Weismann D, Fassnacht M, Weinberger F et al. Intraoperative haemodynamic stability in patients with phaeochromocytoma— minimally invasive versus conventional open surgery. Clin Endocrinol 2006; 65:352–358

    Google Scholar 

  15. Kinney MA, Narr BJ, Warner MA. Perioperative management of pheochromocytoma. J Cardiothorac Vasc Anesthes 2002; 16:359–369

    Article  Google Scholar 

  16. Proye C, Thevenin D, Cecat P, et al. Exclusive use of calcium channel blockers in preoperative and intraoperative control of pheochromocytomas: Hemodynamics and free catecholamine assays in ten consecutive patients. Surgery 1989; 106:1149–1154

    PubMed  CAS  Google Scholar 

  17. McCorkell SJ, Niles NL. Fine-needle aspiration of catecholamine-producing adrenal masses: A possibly fatal mistake. AJR Am J Roentgenol 1985; 145:113–114

    PubMed  CAS  Google Scholar 

  18. Casola G, Nicolet V, van Sonnenberg E, et al. Unsuspected pheochromocytoma: Risk of blood-pressure alterations during percutaneous adrenal biopsy. Radiology 1986; 159:733–735

    PubMed  CAS  Google Scholar 

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Acknowledgment

No financial assistance was received for this work.

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Authors and Affiliations

  1. Endocrine and Diabetes Unit, Department of Medicine, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany

    Dirk Weismann, Martin Fassnacht, Stephanie Hahner & Bruno Allolio

  2. Department of Dermatology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany

    Barbara Schubert

  3. Department of Urology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany

    Roland Bonfig

  4. Department of Radiology, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany

    Alexander Tschammler

  5. Department of General Surgery, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany

    Stephan Timm

  6. Department of Anaesthesia, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany

    Christian Wunder

Authors
  1. Dirk Weismann
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  2. Martin Fassnacht
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  3. Barbara Schubert
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  4. Roland Bonfig
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  5. Alexander Tschammler
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  6. Stephan Timm
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  7. Stephanie Hahner
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  8. Christian Wunder
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  9. Bruno Allolio
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Correspondence to Bruno Allolio.

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Weismann, D., Fassnacht, M., Schubert, B. et al. A Dangerous Liaison—Pheochromocytoma in Patients with Malignant Disease. Ann Surg Oncol 13, 1696–1701 (2006). https://doi.org/10.1245/s10434-006-9184-8

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  • DOI: https://doi.org/10.1245/s10434-006-9184-8

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