Abstract
Cystic adrenal masses are a relatively rare condition, and are usually nonfunctioning and asymptomatic. Differential diagnosis includes pheochromocytoma (PHEO) and adrenal carcinoma; 8–10% of patients with PHEO may be completely asymptomatic. Moreover, fewer than 10% of PHEOs secrete pure epinephrine. We report a case of a E-secreting pure cystic PHEO presenting with an incidental adrenal mass. A 49-year-old Turkish woman was hospitalized at Farabi Hospital for further examinations of a right adrenal cystic mass with a thick wall that was incidentally discovered by abdominal ultrasonography during examination for nausea, vomiting, headache, and angina-like chest pain in another hospital. On admission, her blood pressure was 100/60 mmHg. Tension Holter monitoring revealed paroximal hypertension (178/136 mmHg) and hypotension (78/54 mmHg) attacks. Of urinary catecholamines and its metabolites, only urine metanephrine was markedly increased, despite a urine epinephrine level near the upper limit of normal ranges. Abdominal computed tomography and magnetic resonance imaging studies revealed a cystic round tumor approx 5 cm in diameter, located in the right adrenal gland. Right adrenalectomy was performed; the surgical specimen revealed pure cystic PHEO. Postoperatively, the urine metanephrine level returned to normal range and urine epinephrine level was decreased approx 60%. In conclusion, a diagnosis of E-secreting PHEO should be considered in patients with nonspecific symptoms, presenting with an incidental cystic adrenal mass, even in the absence of hypertension.
Similar content being viewed by others
References
Kudva, Y. C., Sawka, A. M., and Young, W. F. Jr. (2003). J. Clin. Endocrinol. Metab. 88, 4533–4539.
Sawka, A. M., Prebtani, A. P. H., Thabane, L., Gafni, A., Levine, M., and Young, W. F. Jr. (2004). BMC Endocr. Disord. 4, 2.
Manger, W. M. and Gifford, R. W. (2002). J. Clin. Hypertension 4, 62–72.
Klinger, P. J., Fox, T. P., Menke, D. M., Knudsen, J. M., and Fulmer, J. T. (2000). Mayo Clin. Proc. 75, 517–520.
Platts, J. K., Drew, P. T. J., and Harvey, J. N. (1995). J. R. College Physicans Lond. 29, 299–306.
Watson, J. P., Hughes, E. A., Bryan, R. L., Lawson, N., and Barnett, A. H. (1990). Q. J. Med. 279, 747–752.
Olson, S. W., Deal, L. E., and Piesman, M. (2004). Ann. Intern. Med. 140, 849–851.
Erem, C., Celik, F., Reis, A., Hacihasanoglu, A., and Gor, A. (2005). Med. Princ. Pract. 14, 284–287.
Rosenblit, A., Morehouse, H. T., and Amis, E. S. (1996). Radiology 201, 541–548.
Lee, T. H., Slywotzky, C. M., Lavelle, M. T., and Garcia, R. A. (2002). Radiographics 22, 935–940.
Antedomenico, E. and Wascher, R. A. (2005). Curr. Surg. 62, 193–198.
Neumann, H. P., Bausch, B., McWhinney, S. R., Freiburg-Warsaw-Columbus Pheochromocytoma Study Group, et al. (2002). N. Engl. J. Med. 346, 1459–1466.
Scully, R. E., Mark, E. J., McNeely, W. F. et al. (2001). N. Engl. J. Med. 344, 1314–1320.
Plouin, P. F., Degoulet, P., Tugaye, A., Ducrocq, M. B., and Menard, J. (1981). Nouv. Presse Med. 10, 869–872.
Crout, J. R. and Sjoerdsma, A. (1964). J. Clin. Invest. 43, 94–102.
Bravo, E. L. and Tagle, R. (2003). Endocr. Rev. 24, 539–553.
Dunnick, N. R. and Korobkin, M. (2002). Am. J. Roentgenol. 179, 559–568.
Nguyen, H. H., Proye, C. A. G., Carnaille, B., Combemale, F., Pattau, F. N., and Huglo, D. (1999). Aust. N. Z. J. Surg. 69, 350–353.
Malegh, Z., Renyyi-Vamos, F., Tanyay, Z., Koves, I., and Orosz, Z. (1998). Pathol. Res. Pract. 2, 103–106.
Bush, W. H., Elder, J. S., Crane, R. E., and Wales, L. R. (1985). Urology 25, 332–334.
Munden, R., Adams, D. B., and Curry, N. (1993). South Med. J. 86, 1302–1305.
Belden, C. J., Powers, C., and Ros, P. R. (1995). J. Magn. Reson. Imaging 5, 778–780.
Lal, T. G., Kaulback, K. R., Bombonati, A., Palazzo, J. P., Jeffrey, R. B., and Weigel, R. J. (2003). Am. Surg. 69, 812–814.
Kojima, Y., Sugao, H., Yokokawa, K., et al. (1988). Acta Urologica Jpn. 34, 1201–1205.
Mishra, A. K., Agarwal, G., Agarwal, A., and Mishra, S. K. (2001). Surg. Endosc. 15, 220.
Tazi, K., Elmalki, H. O., Ei Fassi, M. J., Koutani, A., Hachimi, M., and Lakrissa, A. (2001). Prog. Urol. 11, 293–295.
Minei, S., Yamashita, H., Koh, H., et al. (2001). Acta Urol. Jpn. 47, 561–563.
Lembke, T. and Greenberg, H. (1987). J. Can. Assoc. Radiol. 38, 232–233.
Chen, W., Chen, K., Ho, D., Chang, L., and Chen, M. (1988). Chin. Med. J. 42, 487–490.
Cession-Fossion, A., Vandermeulen, R., and Lecomte, J. (1967). Rev. Fr. Etud. Clin. Biol. 12, 724–725.
Matoba, T., Fukumoto, A., Takayama, K., Yokota, T., and Toshima, H. (1965). Jpn. Heart J. 6, 483–489.
Nagesser, S. K., Kievit, J., Hermans, J., Karans, H. M., and van de Velde, C. J. (2000). Jpn. J. Clin. Oncol. 30, 68–74.
Shapiro, B. and Fig, L. M. (1989). Endocrinol. Metab. Clin. North Am. 18, 443–481.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Erem, C., Kocak, M., Ersoz, H.Ö. et al. Epinephrine-secreting cystic pheochromocytoma presenting with an incidental adrenal mass. Endocr 28, 225–230 (2005). https://doi.org/10.1385/ENDO:28:2:225
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1385/ENDO:28:2:225