Adrenal pheochromocytoma

ADRENAL PHEOCHROMOCYTOMA ANDREW

C. NOVICK,

44-year-old previously healthy woman presented complaining of headaches, increased sweating, and palpitations. Her blood pressure was 190/110 mmHg. The total (epinephrine and norepinephrine) plasma catecholamine level was 2340 pg/mL. A magnetic resonance imaging scan of the abdomen was obtained. The Tl-weighted image (Fig. 1A) shows a 4-cm solid right adrenal mass. The TZ-weighted image (Fig. 1B) shows that the right adrenal mass has a very high signal intensity, which is diagnostic for pheochromocytoma. An iodine-131-metaiodobenzylguanidine (MIBG) scan (Fig. 2) shows increased uptake of

M.D.

A

FIGURE 2

FIGURE 3

FIGURE 4

FIGURE 1A and B From the Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio Andrew C. Novick, M.D., Department of Urology, The Cleveland Clinic Foundation, Cleveland, OH 44195 Submitted: March 27, 1995, accepted: March 27, 1995 UROLOGYm 46 (31, 1995

isotope by the right adrenal gland with no other areas of increased uptake, confirming the diagnosis of a right adrenal pheochromocytoma. The patient was treated by removal of the right adrenal gland through an anterior subcostal transperitoneal incision. Figure 3 is an operative photograph demonstrating the anatomic relationships of the exposed right adrenal tumor (A) prior to its removal. The tumor lies above the right kidney (K) and renal vein (v) and extends behind the suprarenal inferior vena cava (C) . Figure 4 demonstrates the removed right adrenal gland containing the pheochromocytoma. 405