Pheochromocytoma Presenting as Testicular Pain: An Unusual C
A 51-year-old male with a past medical history of hypertension (diagnosed two years ago, treated with lisinopril 10 mg daily), nephrolithiasis, presented to the hospital with a 3-day complaint of right testicular pain. The pain radiated to the right flank, was intermittent, sharp, 5/10 in severity, aggravated with movement, and alleviated with rest. The pain in the scrotum had not improved, which caused him to present to the emergency department. He denied having hypertensive episodes, headaches, sweating, flushing, and palpitations.

An initial evaluation in the emergency department revealed the following vitals: temperature of 98.6 F, heart rate of 81 beats per minute, blood pressure (BP) of 137/96 mmHg, and oxygen saturation of 97% on room air. Initial laboratory results revealed mild leukocytosis with a white blood cell (WBC) count of 12,900 cells/mL. Due to the patient having acute scrotal pain and elevated WBC count, testicular etiologies such as testicular torsion, epididymitis, varicocele, hydrocele, or chronic testicular pain were ruled out with a thorough physical examination and testicular ultrasound (US). A CT of the abdomen and pelvis without contrast revealed a large right suprarenal mass. A follow-up CT abdomen with adrenal protocol revealed a 5.1 cm enhancing right adrenal mass, which was further detailed with an MRI with contrast. With findings of an adrenal gland mass on imaging, urine and serum analyses were obtained, which revealed elevated catecholamines consistent with possible PCC.

The patient was discharged home as he required perioperative blood pressure management with phenoxybenzamine. The patient was brought back to the hospital 14 days later for transperitoneal robot-assisted laparoscopic right adrenalectomy due to having multiple back surgeries. He was transferred to the intensive care unit (ICU) postoperatively for close monitoring of hemodynamics. The final pathology report revealed a PCC, 6.2 cm in size, with no evidence of necrosis, capsular invasion, or extension into periadrenal adipose tissue. The patient was discharged home on postoperative day three and to follow-up with hematology and oncology for surveillance and possible adjuvant chemotherapy. At follow-up two weeks after discharge, the patient reported complete resolution of his testicular pain.