title: A patient with a large recurrent pheochromocytoma demonstrating the pitfalls of diagnosis.
abstract: BACKGROUND
  A 59-year-old man presented for a follow-up, 6 years after surgery for a large pheochromocytoma. He had suffered from diabetes mellitus, hypertension and abdominal pain in the right flank region. Previous postoperative follow-up did not reveal tumor recurrence.
  
  
  METHODS
  Measurement of plasma free metanephrine and normetanephrine by high-performance liquid chromatography and radioimmunoassay; 123I-metaiodobenzylguanidine (MIBG) scintigraphy; hybrid 123I-MIBG single-photon emission CT (SPECT)-CT; MRI; testing for plasma norepinephrine and epinephrine; intraoperative ultrasonography; histological staining for chromogranin A and synaptophysin; and postoperative 18F-dihydroxyphenylalanine (DOPA) PET scan.
  
  
  METHODS
  Recurrent pheochromocytoma.
  
  
  RESULTS
  Laparotomy with tumor resection. Reduction of antihypertensive medications. Further follow-up by MRI, hybrid 123I-MIBG SPECT-CT and testing for plasma catecholamines and free metanephrines.
authors: Department of Endocrinology and Nephrology, University of Leipzig, 04103 Leipzig, Germany.
authors: Jörg
authors: J
authors: Singer
authors: Christian A
authors: CA
authors: Koch
authors: Woubet
authors: W
authors: Kassahun
authors: Peter
authors: P
authors: Lamesch
authors: Graeme
authors: G
authors: Eisenhofer
authors: Regine
authors: R
authors: Kluge
authors: Thomas
authors: T
authors: Lincke
authors: Matthias
authors: M
authors: Seiwerts
authors: Gudrun
authors: G
authors: Borte
authors: Katrin
authors: K
authors: Schierle
authors: Ralf
authors: R
authors: Paschke
mesh_terms: D015746:Abdominal Pain; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D000959:Antihypertensive Agents / Q000008:administration & dosage; D053379:Chromogranin A / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004837:Epinephrine / Q000097:blood / Q000652:urine; D006801:Humans; D006973:Hypertension / Q000150:complications; D007457:Iodine Radioisotopes; D008279:Magnetic Resonance Imaging; D008297:Male; D008676:Metanephrine / Q000097:blood / Q000652:urine; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D009638:Norepinephrine / Q000097:blood / Q000652:urine; D009647:Normetanephrine / Q000097:blood / Q000652:urine; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D016708:Synaptophysin / Q000032:analysis; D015899:Tomography, Emission-Computed, Single-Photon; D014682:Vena Cava, Inferior / Q000473:pathology
chemical_list: D000959:Antihypertensive Agents; D053379:Chromogranin A; D007457:Iodine Radioisotopes; D016708:Synaptophysin; D009647:Normetanephrine; D008676:Metanephrine; D009638:Norepinephrine; D004837:Epinephrine