title: Modern imaging methods and preoperative management of pheochromocytoma: review of the literature and case report.
abstract: OBJECTIVE
  To discuss the modern imaging techniques and preoperative management of pheochromocytoma and to report on one additional case.
  
  
  METHODS
  A 66-year-old male with an incidentally discovered left adrenal mass is described. The adrenal medulla strongly accumulate 131 I-metaiodobenzylguanidine (MIBG). The patient underwent left adrenalectomy after preoperative therapy with alpha and beta-blockers. The recent literature on pheochromocytoma modern imaging techniques and preoperative management is reviewed.
  
  
  RESULTS
  MIBG scintigraphy diagnosed a benign functioning adrenal pheochromocytoma, allowing preoperative medical management. Postoperative workup was unremarkable. Diagnosis of pheochromocytoma was confirmed by immunohistopathology. At 18 months follow-up, the patient is alive and disease-free.
  
  
  CONCLUSIONS
  Incidentally discovered adrenal masses have to be investigated to detect malignancy and subtle hormonal overproduction. MIBG scintigraphy has a high specificity (100%) in detecting pheochromocytoma, metastasis, surgical residual tumor, local relapse and other adrenal crest tumors. Positive results of octreotide scintigraphy in detecting malignant pheochromocytoma have been reported. Currently, pheochromocytoma removal is a safe operation with mortality rates ranging from 0 to less than 3%. Preoperative alpha adrenergic blockage with phenoxybenzamine or prazosin is important in decreasing the operative risk. Beta-blockers may be necessary for cardiac arrhythmia. Intraoperative invasive monitoring of hemodynamic variables may be both diagnostic and therapeutic of inadequate preoperative management. Lifelong follow-up for patients with pheochromocytoma is important.
authors.affiliation: Cattedra e Divisione Clinicizzata di Urologia, Ospedale Policlinico, Università degli Studi di Verona, Italy.
authors.forename: A B
authors.initials: AB
authors.lastname: Pocaro
authors.forename: S
authors.initials: S
authors.lastname: Cavalleri
authors.forename: C
authors.initials: C
authors.lastname: Ballista
authors.forename: R
authors.initials: R
authors.lastname: Righetti
authors.forename: V
authors.initials: V
authors.lastname: Ficarra
authors.forename: G
authors.initials: G
authors.lastname: Malossini
authors.forename: C
authors.initials: C
authors.lastname: Tallarigo
mesh_terms: D019797:3-Iodobenzylguanidine / Q000493:pharmacokinetics; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D000315:Adrenalectomy; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D010673:Pheochromocytoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine