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Case 77

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A previously healthy 30-year-old female patient complained of dry cough and persistent dyspnea which had begun a month before and showed no response to antibiotics or corticoids. She also reported epigastric pain, vomiting and copious sweating. On examination, she was normotensive and tachycardic. Both computed tomography and 123-I-metaiodobenzylguanidine (MIBG) scintigraphy revealed an adrenal mass.

Taking the clinical data and imaging studies into consideration, it’s reasonable to assert that:

a) The imaging findings are compatible with an adrenal incidentaloma, which has primary adrenal carcinoma as its major cause.

25%

b) Adrenal metastases are the most likely diagnosis.

25%

c) A fine-needle aspiration (FNA) should be carried out to better evaluate the mass.

25%

d) Pheochromocytoma is a potential diagnosis. Therefore, products of catecholamine metabolism (metanephrine and normetanephrine) should be measured either in urine or plasma.

25%
   

Comments

- Ninety percent of the cases of pheochromocytoma refer to adrenal, benign and non-familial tumors.

- Clinical manifestations of pheochromocytomas are exactly the same regardless of their benign or malignant nature.

- Familial disorders related to pheochromocytoma include von Hippel-Lindau (VHL) syndrome and MEN (types 2A and 2B).

- Classic triad: headache, sweating and tachycardia.

- High blood pressure is a common sign of pheochromocytoma, although 5-15 percent of patients might be normotensive.

- Measurements of urinary or plasma metanephrines are the most accurate screening methods.

- Imaging studies of choice: computed tomography (CT) and magnetic resonance imaging (MRI).

- Whole-body 123-I-metaiodobenzylguanidine (MIBG) scintigraphy ought to be done when extra-adrenal tumors are suspected.

- Surgical resection is the definitive treatment.

References

Adrenal incidentalomas - Best Practice & Research Clinical Endocrinology & Metabolism 26 (2012) 69–82.

Pheochromocytoma: recommendations for clinical practice from the First International Symposium - Nature Clinical Practice Endocrinology & Metabolism, February 2007 Vol. 3 Nº 2

UP TO DATE

Clinical presentation and diagnosis of pheochromocytoma.

Treatment of pheochromocytoma in adults.

The adrenal incidentaloma.

Parte inferior do formulário

Pheochromocytoma in genetic disorders.

CECIL, Russell L.; GOLDMAN, Lee; AUSIELLO, D. A. Cecil medicine. 23. ed. Philadelphia: Saunders Elsevier, c2008.

Author

Camila Gomes de Souza Andrade – 5th year medical student of UFMG School of Medicine
e-mail: camila-gomes[arroba]ufmg.br

Advisor

Drª Maria Aparecida Moreira Cosso, Endocrinologist at Madre Teresa Hospital, Belo Horizonte/MG.

e-mail: mmcosso@uai.com.br

Reviewers

Students: Daniel Moore and Emília Valle; Professor Viviane Parisotto 

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