title: Pheochromocytoma in an incidentally discovered asymptomatic cystic adrenal mass.
abstract: Cystic adrenal lesions can be either cortical or medullary, and distinguishing between these 2 types of lesions may be important in patient management. Pheochromocytomas, which are adrenal medullary neoplasms, typically manifest with hypertension, headaches, palpitations, tachycardia, sweating, and anxiety symptoms; however, 10% to 17% of patients with pheochromocytomas are asymptomatic. We describe a 67-year-old woman with lifelong headaches and recent persistent cough in whom a left cystic adrenal mass was incidentally discovered by computed tomography of the chest. A moderate increase in normetanephrine and total metanephrine values in two 24-hour urine samples suggested a pheochromocytoma. Computed tomography with use of contrast medium revealed ring enhancement of the cyst wall, a finding consistent with an adrenal medullary tumor. This report demonstrates the importance of repeated 24-hour urine samples to determine the metanephrine values together with contrast-enhanced computed tomography in a patient with nonspecific symptoms.
authors.affiliation: Department of Surgery, Mayo Clinic Jacksonville, FL 32224, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Klingler
authors.forename: T P
authors.initials: TP
authors.lastname: Fox
authors.forename: D M
authors.initials: DM
authors.lastname: Menke
authors.forename: J M
authors.initials: JM
authors.lastname: Knudsen
authors.forename: J T
authors.initials: JT
authors.lastname: Fulmer
mesh_terms: D000304:Adrenal Cortex Function Tests; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery / Q000652:urine; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008676:Metanephrine / Q000652:urine; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000601:surgery / Q000652:urine; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed
chemical_list: D008676:Metanephrine