Endocrine Abstracts

JOINT3241

Introduction: Pheochromocytoma (PCC) is a rare tumor with potentially fatal complications, namely cardiovascular events and PCC spells. Few cases of PCC treated non-surgically in the elderly have been described.

Methods: we collected data regarding three PCC patients that did not undergo adrenalectomy for various reasons on an average follow up of 5.69 years.

Results: Patient 1 was 75 years old (YO) at diagnosis, he had a tumor diameter of 3.2 cm and refused surgery. He had a stroke 6.6 years after presentation and survived for 14.1 years. His first available 24-h urinary metanephrines and normetanephrines were 5.91 and 1.98 times upper normal limit (UNL) respectively. Blood pressure (BP) treatment was with doxazosin, losartan and bisoprolol. Patient 2 was 86 YO when he had an adrenal mass of 4.9*6.2*4.5 cm found on CT, he wasn’t referred to workup at that time and workup was complete only 7.31 years later, at age 94 when the adrenal mass was 7.4*8.1*8.8 cm and 24-h urinary metanephrines, normetanephrines and methoxytyramine were 12.73, 15.51 and 1.42 times the UNL respectively. He had no cardiovascular events at this time and refused further workup. BP and heart rate (HR) were controlled with doxazosin and metoprolol. Ehocardiography showed an ejection fraction of 45% with diffuse reduction of systolic function and a grade 2 diastolic dysfunction. Patient 3 was 85 YO at diagnosis, with tumor dimensions of 4.5*5.5, she had a positive F-DOPA scan, refused urinary metanephrines collection or any other workup. On a follow up of 0.54 years BP was slightly elevated and was controlled with doxazosin, lercanidipine and bisoprolol. She remained alive with no cardiovascular events. Our average age at diagnosis was 82 years, and average follow up time was 5.69 years. During follow up one patient passed away after 14.1 years of follow up, the same patient experienced a stroke at 6.61 years and a syncope at 2.4 years. No other cardiovascular events were recorded in the other two patients. The average age at end of follow up was 88 years.

Conclusion: in this series of three elderly patients with PCC that did not have an adrenalectomy we found one occurrence of a stroke and one death in the same patient on an average follow up of 5.69 years. It thus seems that medical management may allow satisfactory disease control in select cases in which surgery is not possible or refused by very elderly patients.