title: Adrenal malignant melanoma masquerading as a pheochromocytoma in a patient with a history of a multifocal papillary and medullary thyroid carcinoma.
abstract: OBJECTIVE
  Adrenal masses usually represent benign and nonfunctional adrenal adenomas; however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. We present a rare case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma.
  
  
  METHODS
  A 61-year-old male farmer was referred for evaluation of a mass in the right supraclavicular region and a left adrenal lesion. The patient had a history of a multifocal papillary and medullary thyroid carcinoma. Laboratory tests revealed increased 24hour urinary dopamine and also increased serum calcitonin and neuron specific enolase. A pathology report of the resected right supraclavicular mass and left adrenal showed a malignant melanoma.
  
  
  CONCLUSIONS
  This is a case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. Although this case is very rare and there are rigid diagnostic criteria for the diagnosis of primary adrenal melanoma, it underlines the fact that the differential diagnosis of a dopamine secreting adrenal mass should include primary or metastatic malignant melanoma in order to determine the best diagnostic approach for the patient and select the most appropriate surgical management.
authors.affiliation: Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece. barbari_maria@yahoo.com.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Barmpari
authors.affiliation: Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Savvidis
authors.affiliation: Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece.
authors.forename: Anastasia D
authors.initials: AD
authors.lastname: Dede
authors.affiliation: Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Athens, Greece.
authors.forename: Haridimos
authors.initials: H
authors.lastname: Markogiannakis
authors.affiliation: Department of Pathology, Hippokration Hospital, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Dikoglou
authors.affiliation: Section of Endocrinology and Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Xekouki
authors.affiliation: Section of Endocrinology and Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Stratakis
authors.affiliation: Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Athens, Greece.
authors.forename: Manouras
authors.initials: M
authors.lastname: Andreas
authors.affiliation: Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malaktari-Skarantavou
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery / Q000652:urine; D000315:Adrenalectomy; D014408:Biomarkers, Tumor / Q000097:blood / Q000652:urine; D001706:Biopsy; D002116:Calcitonin / Q000097:blood; D002277:Carcinoma / Q000473:pathology*; D018278:Carcinoma, Neuroendocrine / Q000473:pathology*; D002291:Carcinoma, Papillary; D003937:Diagnosis, Differential; D004298:Dopamine / Q000652:urine; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000097:blood / Q000473:pathology* / Q000601:surgery / Q000652:urine; D008875:Middle Aged; D010673:Pheochromocytoma / Q000473:pathology*; D010751:Phosphopyruvate Hydratase / Q000097:blood; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002116:Calcitonin; D010751:Phosphopyruvate Hydratase; D004298:Dopamine