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Bilateral Pheochromocytoma importance of multimodality imaging assessment.
MedLine Citation:
PMID:  24862676     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: bilateral pheochromocytomas ( PHEO ) are rare, often hereditary and linked to a germline mutation of RET, VHL or SDHx. However they also occur sporadically.
PRESENTATION OF CASE: we report a case of a 76 year old female hospitalized for biological investigations following symptoms of abdominal discomfort with recurrent hypertensive episodes. The hormonal work up results favoured a diagnosis of a PHEO (urinary and plasma metanephrines > 10 times normal). Radiological investigations (CT-MRI): identified bilateral adrenal masses (47 mm in the right adrenal, 26 mm in the left adrenal). Functional imaging with I 123 MIBG scintigraphy showed intense uptake in the right adrenal mass with limited uptake in the left, probably related to a fixation of the normal adrenal medulla. Due to the strong suspicion of bilateral PHEO, further imaging with an 18F-FDOPA PET was performed. This revealed intense hypermetabolism of the right mass but the left mass had similar metabolism to the liver, thought to be unsuspicious for a PHEO. It was decided to proceed with a laparoscopic right adrenalectomy. Hormonal investigations performed post-operatively revealed persistently elevated metanephrines and an 18F-FDG PET was performed, revealing an intense hypermetabolic focus in the left adrenal gland. A laparoscopic partial left adrenalectomy was subsequently performed 6 weeks after the initial right adrenalectomy.
DISCUSSION AND CONCLUSIONS: this case highlights the possibility of false negative results using specific functional imaging. In these situations, 18F-FDG PET may be useful. The MRI signal has an indisputable value. Until today, no germline mutation was found in this patient on RET, SDHx or VHL genes.
Authors:
Nunzia Cinzia Paladino; Aoife Lowery; Carole Guerin; David Taieb; Frédéric Sebag
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-23
Journal Detail:
Title:  International journal of surgery (London, England)     Volume:  -     ISSN:  1743-9159     ISO Abbreviation:  Int J Surg     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101228232     Medline TA:  Int J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014. Published by Elsevier Ltd.
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