Endocrine Abstracts (2010) 22 P15

Pheochromocytoma in an incidentally discovered cystic adrenal mass: a case report

Ayten Oguz1, Pamir Eren Ersoy2, Melike Metin Sugutlugil3, Gulnur Guler4, Reyhan Ersoy1 & Bekir Cakir1

1Department of Endocrinology and Metabolism, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey; 2Department of 3. General Surgery, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey; 3Department of Radiology, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey; 4Department of 2. Pathology, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey.

Introduction: Adrenal cysts are rare usually benign and asymptomatic. Histologically, they are classified as epithelial, endothelial, parasitic and pseudocysts. Although extremely rare and clinically more dramatic cystic adrenal carcinoma and cystic pheochromocytoma must be considered in the differential diagnosis of adrenal cysts. In this report, we presented a patient with a large cystic pheochromocytoma.

Case report: A 30-year-old female patient admitted our clinic with a left sided adrenal mass detected incidentally on a routine control. Her passed medical history was unremarkable. She had no episodic hypertensive attack, no complaint of sweating or headache. Vital signs were normal, with a heart rate of 72 beats/min and a blood pressure of 110/70 mmHg. Physical examination was completely normal. Adrenal MRI revealed a 72×59×75 mm lesion at the left adrenal lodge with septations. The mass did not show any contrast enhancement and was reported as type III hydatid cyst. In contrast, the hemmaglutination test was negative. The eosinophil count was normal. Serum potassium levels were normal. Urine normetanephrine and VMA were markedly increased. Left adrenalectomy was performed. The patient’s intra-operative and postoperative courses were uncomplicated. The surgical specimen revealed pure cystic pheochromocytoma. Postoperatively the urine normetanephrine and VMA levels returned in to the normal range.

Conclusion: Cystic pheochromocytomas may not present with the classic prodromal symptoms, which are commonly associated with solid pheochromocytomas. This case represents an unsuspected presentation of an extremely rare functional cystic neoplasm. Pheochromocytoma should be considered in patients presenting with an incidental cystic adrenal mass, even in the absence of hypertension.

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