title: Incidental Phaeochromocytoma on Staging PET-CT in a Patient with a Sigmoid Tumour and Situs Inversalis Totalis.
abstract: An adrenal "incidentaloma" is defined as an unexpected finding on radiological imaging performed for unrelated indications. Improvements in radiological technology have seen a dramatic increase in this phenomenon. We report the unique case of a 60-year-old female presenting with a 6-month history of abdominal pain, altered bowel habit, and rectal bleeding. Her past medical history included situs inversus totalis and a patent ductus arteriosus. Colonoscopy revealed an ulcerated tumour in her sigmoid colon. Staging PET-CT confirmed a sigmoid tumour and also identified a large heterogenous enhancing FDG-avid right adrenal mass. Biochemical testing/MIBG imaging confirmed a right adrenal phaeochromocytoma. Hypertension was controlled and excision was performed via a transperitoneal laparoscopic adrenalectomy, in the left lateral decubitus position. Uniquely, liver retraction was not required due to its position in the left hypochondrium. Histology confirmed a benign 46 mm phaeochromocytoma. Subsequent uncomplicated sigmoid colectomy/right salpingo-oophorectomy for a locally advanced colonic tumour was performed with adjuvant chemotherapy. This case highlights the importance of accurately identifying functioning adrenal tumours before elective surgery as undiagnosed phaeochromocytomas carry significant intraoperative morbidity/mortality. Right adrenalectomy was made easier in this patient by the liver's unique position. Uncomplicated colorectal resection was made possible by combined preoperative functional/anatomical imaging.
authors.affiliation: The Department of Endocrine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: M R
authors.initials: MR
authors.lastname: Boland
authors.affiliation: The Department of Endocrine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lowery
authors.affiliation: The Department of Endocrine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Walsh
authors.affiliation: The Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Beddy
authors.affiliation: The Department of Endocrine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: R S
authors.initials: RS
authors.lastname: Prichard
authors.affiliation: The Department of Endocrinology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Shea
authors.affiliation: The Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: S J
authors.initials: SJ
authors.lastname: Skehan
authors.affiliation: The Department of Endocrine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: E W
authors.initials: EW
authors.lastname: McDermott
references.citation: J Endocrinol Invest. 2007 Sep;30(8):647-52
references.pmid: 17923795
references.citation: Int J Cardiol. 2003 Apr;88(2-3):143-55; discussion 155-6
references.pmid: 12714192
references.citation: World J Surg. 1990 May-Jun;14(3):317-24
references.pmid: 2195784
references.citation: J Surg Res. 2007 Jun 15;140(2):159-64
references.pmid: 17196989
references.citation: Anaesth Intensive Care. 1998 Apr;26(2):196-200
references.pmid: 9564401
references.citation: J Pediatr Surg. 2006 Jul;41(7):1237-42
references.pmid: 16818055
references.citation: J Urol. 2001 Aug;166(2):429-36
references.pmid: 11458042
references.citation: Ann Surg. 2005 Jun;241(6):919-26; discussion 926-8
references.pmid: 15912041
references.citation: Ann Intern Med. 2003 Mar 4;138(5):424-9
references.pmid: 12614096
references.citation: Indian J Endocrinol Metab. 2011 Oct;15 Suppl 4:S337-44
references.pmid: 22145137
references.citation: AJR Am J Roentgenol. 2007 Jun;188(6 Suppl):S39-49; quiz S35-8
references.pmid: 17515336
references.citation: Endocr Pract. 2008 Dec;14(9):1137-49
references.pmid: 19158054
references.citation: J Endocrinol Invest. 2006 Apr;29(4):298-302
references.pmid: 16699294