title: Serendipity in the diagnosis of pheochromocytoma.
abstract: OBJECTIVE
  Pheochromocytomas are increasingly being discovered incidentally on imaging studies performed without clinical suspicion of the existence of an adrenal lesion. We aimed to determine the rate of diagnosis of adrenal pheochromocytoma as an incidental finding during a recent 7-year period.
  
  
  METHODS
  We obtained the Department of Pathology database to study all the patients at our institution with newly diagnosed pheochromocytomas in the 7-year period from 2005 to 2011 to determine the clinical presentation and the means of diagnosis.
  
  
  RESULTS
  In 40 (70.2%) of the 57 patients, an adrenal pheochromocytoma was detected in an imaging study performed without suspicion of an adrenal lesion. There were 13 chest computed tomography studies-8 to evaluate for possible pulmonary emboli. Other indications included abdominal pain or discomfort (n = 8), trauma (n = 3), abnormal liver function tests (n = 3), suspect renal artery stenosis (n = 3), hematuria (n = 2), colitis (n = 2), and 4 miscellaneous indications.
  
  
  CONCLUSIONS
  Our study documents that the commonest current means of initial detection of pheochromocytoma is by serendipitous discovery. In 16 of our 40 patients with serendipitously discovered pheochromocytomas, there were no clinical symptoms of pheochromocytoma; these were true incidentalomas. More than two thirds of the new cases of pheochromocytoma were detected by serendipity (found during studies not performed to evaluate for pheochromocytoma), approximately one third were true incidentalomas (pheochromocytomas in patients without symptoms).
  
  
  CONCLUSIONS
  In a 7-year period at a single institution, 40 patients, 70% of new cases of surgically proven pheochromocytoma, were initially detected by serendipity. Sixteen patients, 40% of those incidentally discovered represented true examples of "incidentalomas."
authors.affiliation: From the Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Alexander Roman
authors.initials: AR
authors.lastname: Oshmyansky
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Mahammedi
authors.forename: Alan
authors.initials: A
authors.lastname: Dackiw
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Ball
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Martha A
authors.initials: MA
authors.lastname: Zeiger
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Siegelman
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*