Endocrine Abstracts

JOINT161

Introduction: Pheochromocytoma is a rare neuroendocrine tumor. It was a tumor arising from adrenomedullary chromaffin cells that commonly produce one or more catecholamines. They produce and secrete catecholamine. Cystic pheochromocytoma is a rare entity and mostly asymptomatic. Considering the rarity and difficulty to differentiate from simple cysts in the absence of classic clinical symptoms, we present a huge cystic pheochromocytoma.

Case Report: This is a 63-year-old patient with no previous history of the disease, who presented with a cystic phoechromocytoma revealed by low back pain, which prompted an abdominal CT scan showing a 15 cm cystic left surrenal mass, confirmed biologically by a methoxylated derivative assay that was 7 times normal. The patient did not present with Menard’s triad or hypertension. She underwent laparoscopic unilateral adrenalectomy after medical preparation. The evolution was marked by the negativation of the biological work-up postoperatively and the anatomopathological examination confirmed the diagnosis.

Discussion: Cystic pheochromocytoma is a rare entity and it may be due to intralesional hemorrhage, necrosis and liquefaction. Patients with cystic pheochromocytomas are usually asymptomatic. Hormonal analysis is generally negative. the main clinical signs are represented by the non-specific triad of low back pain, digestive problems and lumbar mass. These cystic forms of pheochromocytoma pose a real problem of differential diagnosis. The differential diagnosis is made with haemorrhagic lesions, cystic lymphangiomas, adenomas, metastases, vascular tumours of the adrenal gland, hydatid cysts and other cystic masses in the vicinity. The radiological study of the adrenal gland is based on CT. The typical radiological characteristics of pheochromocytoma are a round or oval mass, well-circumscribed, homogeneous or heterogeneous measuring>4 cm, increased attenuation on unimproved enhancement, significant vascularization of the mass. However, the CT characteristics of cystic pheochromocytomas would be a relatively thick wall, the presence or absence of septa in the mass and persistent enhancement of the wall after the administration of contrast media. On the other hand,123I-MIBG scintigraphy has a higher diagnostic specificity. 18F-FDG positron emission tomography/CT can also allow the successful visualization of pheochromocytomas. Preoperative management is essential to prevent hemodynamic instability during the intraoperative or postoperative period. The treatment of cystic pheochromocy tomas is based on surgery.

Conclusion: Measurement of methoxylated derivatives in the urine should therefore be systematically requested in the presence of any adrenal mass.

References: Rahoui Moez* Journal of Surgical Case Reports, 2021;5, 1–3K. TAZI et al, Progrès en Urologie (2001), 11, 293-295