Adrenal Adenoma Anarchy: A Case of an ACTH-Secreting Pheochr
Released: Doctor's guide to managing the Coronavirus/COVID19 outbreakWatch VideoDownload SlidesReleased: Doctor's guide to managing the Coronavirus/COVID19 outbreakWatch VideoDownload Slides
Pheochromocytomas are rare neuroendocrine tumors that arise from sympathetic adrenomedullary chromaffin tissue. Presentations are variable depending on the amount of catecholamine secretion. Classically, patients present with the nonspecific triad of palpitations, headaches, and/or sweating, although recent studies have found only 17% of patients diagnosed with pheochromocytoma to present classically.

A 64-year-old woman with a history of colon cancer presented with new-onset diabetes, worsening hot flashes, and hypertension. On CT imaging she had an enlarging right adrenal nodule (1.7 cm) with 60 Hounsfield units of attenuation and no PET avidity. The biochemical evaluation showed elevated urinary and plasma metanephrines, elevated plasma cortisol levels despite dexamethasone suppression, elevated late-night salivary cortisol, and high-normal adrenocorticotrophic hormone. The patient underwent laparoscopic right adrenalectomy, and pathology confirmed pheochromocytoma. Her lab abnormalities and symptoms of hot flashes and hypertension improved postoperatively.

Conclusively, This case demonstrates an unusual ACTH-secreting pheochromocytoma with subtle presentation and highlights the importance of obtaining a complete biochemical evaluation of incidental adrenal adenomas.

G R K●●●●a V●●●●●●i
G R K●●●●a V●●●●●●i General Medicine
Can anyone explain the pathophysiology behind this unusual Pheochromocytoma?
Mar 24, 2020Like