Modern imaging methods and preoperative management of pheochromocytoma: review of the literature and case report.
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.
Pocaro
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AB
Cattedra e Divisione Clinicizzata di Urologia, Ospedale Policlinico, Università degli Studi di Verona, Italy.
Cavalleri
S
S
Ballista
C
C
Righetti
R
R
Ficarra
V
V
Malossini
G
G
Tallarigo
C
C
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
D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine