Endocrine Abstracts

Introduction: Pheochromocytoma is an adrenal medullary tumor which typically involves nonspecific symptoms like arterial blood hypertension, tachycardia, headache or sweating. In some cases, patients may be completely asymptomatic at onset and exceptionally develop symptoms after surgery.

Case presentation: We present two cases, first one of a 36 years old male, in which an MRI scan for evaluation of the spine revealed an oval, well-contoured heterogeneous mass of 10/9.6/11 mm in the right adrenal gland. At presentation, the patient was asymptomatic and the clinical evaluation was entirely normal. The diagnosis of pheochromocytoma was established based on extremely high levels of plasma cathecolamines. The patient was successfully operated and remained well. The second case, a 69 years old female, obese, presented for evaluation after a left adrenal mass was discovered on a routine abdominal ultrasound. Abdominal CT scan identified a 66/51/63 mm left adrenal mass. No signs or symptoms suggestive of overactive adrenals were present. She presented very high values of metanephrines and normetanephrines, which normalised after successful surgery. Despite that, she developed significant arterial hypertension few days postoperatively, which persisted and required specific treatment.

Conclusions: Widely variable clinical presentation may be present in patients with pheochromocytoma, before or after the surgery, possibly regardless of the tumor dimension. Hypertension developed after intervention could be explained by concomitant secretion of vasodilator agents from the tumor.