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A patient with a large recurrent pheochromocytoma demonstrating the pitfalls of diagnosis

Nature Reviews Endocrinology volume 7, pages 749–755 (2011)Cite this article

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Abstract

Background. A 59-year-old man presented for a follow-up, 6 years after surgery for a large pheochromocytoma. He had suffered from diabetes mellitus, hypertension and abdominal pain in the right flank region. Previous postoperative follow-up did not reveal tumor recurrence.

Investigation. Measurement of plasma free metanephrine and normetanephrine by high-performance liquid chromatography and radioimmunoassay; 123I-metaiodobenzylguanidine (MIBG) scintigraphy; hybrid 123I-MIBG single-photon emission CT (SPECT)–CT; MRI; testing for plasma norepinephrine and epinephrine; intraoperative ultrasonography; histological staining for chromogranin A and synaptophysin; and postoperative 18F-dihydroxyphenylalanine (DOPA) PET scan.

Diagnosis. Recurrent pheochromocytoma.

Management. Laparotomy with tumor resection. Reduction of antihypertensive medications. Further follow-up by MRI, hybrid 123I-MIBG SPECT–CT and testing for plasma catecholamines and free metanephrines.

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Figure 1: 123I-metaiodobenzylguanidine scintigraphy in the case patient.
Figure 2: 123I-metaiodobenzylguanidine (MIBG) scintigraphy with single-photon emission CT (SPECT)–CT in the case patient.
Figure 3
Figure 4: Histology and immunhistochemistry of tissue samples taken at the second surgery of the case patient.

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Acknowledgements

Written consent for publication was obtained from the patient.

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Endocrinology and Nephrology, University of Leipzig, 04103 Leipzig, Germany,

    Jörg Singer & Ralf Paschke

  2. Surgical Department II, University of Leipzig, 04103 Leipzig, Germany,

    Woubet Kassahun

  3. Department of Radiology, Liebigstraβe 20, University of Leipzig, 04103 Leipzig, Germany,

    Matthias Seiwerts & Gudrun Borte

  4. Department of Nuclear Medicine, Liebigstraβe 18, University of Leipzig, 04103 Leipzig, Germany,

    Regine Kluge & Thomas Lincke

  5. Department of Pathology, Liebigstraβe 26, University of Leipzig, 04103 Leipzig, Germany,

    Katrin Schierle

  6. Division of Endocrinology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA,

    Christian A. Koch

  7. Department of General Surgery, Delitzscher Straβe 141, Sankt Georg Hospital Leipzig, 04129 Leipzig, Germany,

    Peter Lamesch

  8. Institute of Clinical Chemistry & Laboratory Medicine and Department of Medicine, Fetscherstraβe 74, University of Dresden, 01307 Dresden, Germany,

    Graeme Eisenhofer

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Contributions

J. Singer, C. A. Koch, G. Eisenhofer, M. Seiwerts, G. Borte, K. Schierle and R. Paschke researched the data for the article. J. Singer, C. A. Koch, W. Kassahun, P. Lamesch, G. Eisenhofer, M. Seiwerts, G. Borte and R. Paschke provided a substantial contribution to discussions of the content. J. Singer, C. A. Koch and R. Paschke wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Jörg Singer.

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Singer, J., Koch, C., Kassahun, W. et al. A patient with a large recurrent pheochromocytoma demonstrating the pitfalls of diagnosis. Nat Rev Endocrinol 7, 749–755 (2011). https://doi.org/10.1038/nrendo.2011.132

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