title: Pheochromocytoma as a rare cause of arterial hypertension in a patient with autosomal dominant polycystic kidney disease: A diagnostic and therapeutic dilemma.
abstract: BACKGROUND
  Individuals with autosomal dominant polycystic kidney disease (ADPKD) frequently suffer arterial hypertension even prior to significant loss of renal function, a clinical situation that obscures detection of modifiable secondary causes of hypertension.
  
  
  METHODS
  A 50-year-old man with ADPKD and polycystic liver and resistant hypertension is diagnosed with a 4-cm right adrenal mass. Cross-sectional MRI is indicative of pheochromocytoma versus adrenocortical carcinoma or metastasis, though there are no typical PCC symptoms and plasma and urine metanephrines are within normal ranges. Since malignancy cannot be excluded, right adrenalectomy is performed. Considering that the enlarged liver poses an obstacle for transperitoneal open and laparoscopic approaches, a retroperitoneoscopic approach is used. Surgical pathology reveals a 4.5-cm pheochromocytoma; the patient no longer requires antihypertensive therapy.
  
  
  CONCLUSIONS
  Pheochromocytoma is a rare but treatable cause of hypertension in ADPKD; given the anatomical complexities these patients present, careful preoperative planning and surgical technique are essential to a favorable outcome.
authors.affiliation: Endocrine Surgery, Department of General and Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM) Hospital Clínic, University of Barcelona, Barcelona, Spain. Electronic address: ajhesshe@clinic.ub.es.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Hessheimer
authors.affiliation: Endocrine Surgery, Department of General and Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM) Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Vidal
authors.affiliation: Endocrine Surgery, Department of General and Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM) Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Mauro
authors.initials: M
authors.lastname: Valentini
authors.affiliation: Endocrine Surgery, Department of General and Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM) Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
keywords: Adrenalectomy; Hypertension; Pheochromocytoma; Polycystic kidney; Polycystic liver; Retroperitoneoscopy