Endocrine Abstracts

Introduction: Pheochromocytomas/paragangliomas (PPGL) are rare tumours derived from chromaffin cells of the adrenal medulla or autonomic nervous system. In the past, most cases had imaging triggered by symptoms suggestive of phaeochromocytoma. We present 11 cases of incidentally found pheochromocytomas and paragangliomas diagnosed in the last 5 years.

Methods: We reviewed hospital records of all patients who were diagnosed with PPGL in Birmingham Heartlands Hospital from 2019 to present date. The reason for the scan, clinical and biochemical features as well as the management was analysed.

Results: The cohort included 11 patients (7 males, 4 females) with the median age of 66 (44-85) years who underwent imaging for abdominal pain on contralateral side, lung health check, staging scans for cancer, suspected pulmonary embolism or weight loss. Nine patients were diagnosed with phaeochromocytomas and 2 with paragangliomas of which 1 was non-secretory. All were found incidentally. The median size of the adrenal/paraganglioma lesions was 6.3 (2.5 to 10) cm. Elevated nor metadrenaline levels were observed in all secretory PPGLs, with a median of 12,197 (2342 to >30,000) pg/ml. Metadrenaline was also elevated in 3 cases with mean level of 876 pg/ml. All patients were blocked with doxazosin (total daily dose of 8-24 mg) in preparation for surgery. Surgical intervention was performed in 9 cases, all but 1 adrenalectomies, with 2 cases managed conservatively with alpha-blockade as not suitable for surgery due to frailty. Two patients had a small residual or recurrent disease treated with alpha-blockade.

Conclusion: This series emphasizes the importance of recognizing incidental pheochromocytomas during imaging. Timely biochemical evaluation, alpha-blockade and surgical intervention can lead to favorable outcomes, although ongoing monitoring is essential to manage recurrent disease.