M Earth Hasassri1, T K Pandian2, Aleh A Bobr3, Irina Bancos4, William F Young4, Melanie L Richards2, David R Farley2, Geoffrey B Thompson2, Travis J McKenzie5. 1. Mayo Medical School, Rochester, MN, USA. 2. Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55901, USA. 3. Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA. 4. Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. 5. Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55901, USA. McKenzie.Travis@mayo.edu.
Abstract
BACKGROUND: Pheochromocytoma with synchronous ipsilateral adrenal cortical adenoma (PSCA) may present with mixed clinical, biochemical, and radiological features characteristic to each neoplasm subtype. METHODS: All patients with a pathological diagnosis of pheochromocytoma were evaluated for an ipsilateral cortical adenoma from 1994 through 2015. Retrospectively extracted data included indications for adrenalectomy, diagnostic workup (biochemical and radiographic), operative characteristics, pathological findings, and postoperative complications. RESULTS: Sixteen of 413 patients (4%) undergoing adrenalectomy for pheochromocytoma had a PSCA. Median patient age was 57.7 years (IQR 50.1, 63.1); 50% were male. On imaging, 75% of the adrenal neoplasms were found incidentally and only 50% were reported to have a synchronous ipsilateral neoplasm based on imaging findings. Clinically important cortical hormone secretion was diagnosed in 38% of these patients; 25% had glucocorticoid secretory autonomy; and 13% had primary aldosteronism. CONCLUSION: Physicians should be aware that adrenal neoplasms with mixed diagnostic findings may represent PSCA. Evaluation should be performed on this co-occurrence to prevent perioperative complications from resection of an unexpected secretory cortical neoplasm.
BACKGROUND:Pheochromocytoma with synchronous ipsilateral adrenal cortical adenoma (PSCA) may present with mixed clinical, biochemical, and radiological features characteristic to each neoplasm subtype. METHODS: All patients with a pathological diagnosis of pheochromocytoma were evaluated for an ipsilateral cortical adenoma from 1994 through 2015. Retrospectively extracted data included indications for adrenalectomy, diagnostic workup (biochemical and radiographic), operative characteristics, pathological findings, and postoperative complications. RESULTS: Sixteen of 413 patients (4%) undergoing adrenalectomy for pheochromocytoma had a PSCA. Median patient age was 57.7 years (IQR 50.1, 63.1); 50% were male. On imaging, 75% of the adrenal neoplasms were found incidentally and only 50% were reported to have a synchronous ipsilateral neoplasm based on imaging findings. Clinically important cortical hormone secretion was diagnosed in 38% of these patients; 25% had glucocorticoid secretory autonomy; and 13% had primary aldosteronism. CONCLUSION: Physicians should be aware that adrenal neoplasms with mixed diagnostic findings may represent PSCA. Evaluation should be performed on this co-occurrence to prevent perioperative complications from resection of an unexpected secretory cortical neoplasm.
Authors: Amir H Hamrahian; Adriana G Ioachimescu; Erick M Remer; Gaspar Motta-Ramirez; Hari Bogabathina; Howard S Levin; Sethu Reddy; Inderbir S Gill; Allan Siperstein; Emmanuel L Bravo Journal: J Clin Endocrinol Metab Date: 2004-11-30 Impact factor: 5.958