Endocrine Abstracts (2012) 28 P148

Radiological diagnosis frequently precedes clinical suspicion and biochemical confirmation in phaeochromocytoma: a pilot series

Julia Prague1, Dylan Lewis2, Pauline Kane2, Gill Vivian2, Benjamin Whitelaw1, Shamin Ramasamy1, Royce Vincent3, Klaus-Martin Schulte4, Alan McGregor1 & Simon Aylwin1

1Department of Endocrinology, King's College Hospital, London, United Kingdom; 2Department of Radiology, King's College Hospital, London, United Kingdom; 3Department of Biochemistry, King's College Hospital, London, United Kingdom; 4Department of Surgery, King's College Hospital, London, United Kingdom.

Background: Kopetschke et al. (2009) suggested that nearly thirty per-cent of adrenal/extra-adrenal phaeochromocytoma were found incidentally1. However, they included cases from 1973 to 2007, whereas in the modern era CT and MR investigations are requested more frequently and earlier in the diagnostic algorithm.

Methods: We report a pilot series of consecutive referrals to a tertiary centre for adrenal and extra-adrenal phaeochromocytoma from July to October 2011.

Results: Six patients were referred in this period (6F mean age 53 yr). Two were acute medical admissions and four from DGHs of which three had presented acutely: two with catecholamine crisis requiring immediate ITU admission. Retroperitoneal masses were noted on imaging and resulted in the diagnosis of phaeochromocytoma being considered and then confirmed in five of the six patients. Suspected diagnoses were: CT for pulmonary embolism (two), CT for aortic dissection, USS for hypertension, spinal MR for surveillance). In no case had biochemical tests been requested prior to imaging. In retrospect, all had complained of paroxysmal palpitations; symptom duration 2–20 yr. Five patients had presented to secondary care previously with symptoms consistent with phaeochromocytoma. Three had long-standing hypertension. One had a known genetic condition associated with phaeochromocytoma (NF1).

Conclusions: In this pilot series, imaging led to the diagnosis of phaeochromocytoma being considered prior to biochemical investigation and in many the diagnosis was unsuspected despite symptoms being present. Despite the increasing availability of improved screening tests for catecholamine excess, phaeochromocytoma is rarely suspected in symptomatic patients. 1 Eur J Endocrinol 161: 365–361.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.