A dangerous liaison--pheochromocytoma in patients with malignant disease.
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.
Weismann
Dirk
D
Endocrine and Diabetes Unit, Department of Medicine, University of Wuerzburg, Josef-Schneider-Str. 2, Wuerzburg, D-97080, Germany.
Fassnacht
Martin
M
Schubert
Barbara
B
Bonfig
Roland
R
Tschammler
Alexander
A
Timm
Stephan
S
Hahner
Stephanie
S
Wunder
Christian
C
Allolio
Bruno
B
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