title: A dangerous liaison--pheochromocytoma in patients with malignant disease.
abstract: BACKGROUND
  Adrenal masses in patients with known malignancy may be interpreted as metastasized disease, although a significant proportion of these tumors are of adrenal origin. Despite improved imaging techniques, it remains difficult to distinguish an adrenal metastasis from a pheochromocytoma or a lipid-poor adrenocortical adenoma.
  
  
  METHODS
  We report a case series of four patients with established or suspected malignant disease (melanoma, transitional cell carcinoma and prostate carcinoma, thyroid carcinoma, colorectal carcinoma) harboring an adrenal mass. None of these patients showed clinical symptoms indicative for a pheochromocytoma.
  
  
  RESULTS
  Surgery unrelated to the adrenal lesion (n = 3) or biopsy of the adrenal mass (n = 1) was performed without prior endocrine work-up. Pronounced hemodynamic instability including hypertensive crisis was observed during surgery in all patients. In contrast, in the same patients preoperative alpha-blockade with phenoxybenzamine and an increased awareness of the potential risks led to improved hemodynamic stability following adrenalectomy for pheochromocytoma.
  
  
  CONCLUSIONS
  Our series is a strong reminder of the risks associated with surgery in patients harboring an unsuspected pheochromocytoma and underscores the need to exclude a pheochromocytoma in all patients with an adrenal mass and without a definitive diagnosis of the mass, especially when they are scheduled for surgery or adrenal biopsy. Otherwise, life-threatening hypertensive crisis can be precipitated even in the previously asymptomatic patient.
authors.affiliation: Endocrine and Diabetes Unit, Department of Medicine, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Weismann
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.forename: Barbara
authors.initials: B
authors.lastname: Schubert
authors.forename: Roland
authors.initials: R
authors.lastname: Bonfig
authors.forename: Alexander
authors.initials: A
authors.lastname: Tschammler
authors.forename: Stephan
authors.initials: S
authors.lastname: Timm
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Christian
authors.initials: C
authors.lastname: Wunder
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology*; D010673:Pheochromocytoma / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000628:therapy