Adrenal Pheochromocytoma with Involvement of Aorta and Left Renal Artery: Salvaged with Adrenalectomy and Nephrectomy

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2021 Sep 13

PMID 34511410

Citations 1

Authors

Shekhar Sathaye

Kalpesh Mahesh Parmar

Santosh Kumar

Pulkit Rastogi

Affiliations

Soon will be listed here.

Abstract

Large adrenal pheochromocytomas encasing the renal artery are a rare entity. The management of such challenging cases is surgical resection. The involvement of renal tissue and renal artery may necessitate meticulous dissection and concomitant nephrectomy. Here, we present a case of 41-year-old man diagnosed with left adrenal pheochromocytoma with complete encasement of left renal artery and partial encasement of aorta. Open left adrenalectomy and nephrectomy was performed after adequate preoperative optimisation. The patient is doing well at 6-month follow-up. Large adrenal pheochromocytoma with renal involvement is a rare presentation and requires optimal preoperative imaging, adequate preoperative alpha and beta blockade and meticulous surgical technique.

Citing Articles

Unique Presentation and Perioperative Management of a Giant Pheochromocytoma.

Villarraga N, Palani G, Risk M, Sibley S JCEM Case Rep. 2023; 1(3):luad065.

PMID: 37908578 PMC: 10580415. DOI: 10.1210/jcemcr/luad065.

References

Kota S, Kota S, Meher L, Tripathy P, Sruti J, Modi K . Pheochromocytoma with renal artery stenosis: A case-based review of literature. J Cardiovasc Dis Res. 2012; 3(1):36-9. PMC: 3271680. DOI: 10.4103/0975-3583.91601. View

Gul Z, Liaw C, Reddy A, Mehrazin R . Robotic-Assisted Partial Nephrectomy and Adrenalectomy: Case of a Pheochromocytoma Invading into Renal Parenchyma. Case Rep Urol. 2020; 2020:7321015. PMC: 7322583. DOI: 10.1155/2020/7321015. View

Eisenhofer G, Huynh T, Hiroi M, Pacak K . Understanding catecholamine metabolism as a guide to the biochemical diagnosis of pheochromocytoma. Rev Endocr Metab Disord. 2001; 2(3):297-311. DOI: 10.1023/a:1011572617314. View

Chang C, Pattison D, Tothill R, Kong G, Akhurst T, Hicks R . (68)Ga-DOTATATE and (18)F-FDG PET/CT in Paraganglioma and Pheochromocytoma: utility, patterns and heterogeneity. Cancer Imaging. 2016; 16(1):22. PMC: 4989291. DOI: 10.1186/s40644-016-0084-2. View

Eisenhofer G, Goldstein D, Kopin I, Crout J . Pheochromocytoma: rediscovery as a catecholamine-metabolizing tumor. Endocr Pathol. 2003; 14(3):193-212. DOI: 10.1007/s12022-003-0012-4. View

Eisenhofer G, Goldstein D, Walther M, Friberg P, Lenders J, Keiser H . Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab. 2003; 88(6):2656-66. DOI: 10.1210/jc.2002-030005. View

Costa S, Cabral N, Abhrao A, da Costa R, Silva L, Lupinacci R . Giant cystic malignant pheochromocytoma invading right hepatic lobe: report on two cases. Sao Paulo Med J. 2008; 126(4):229-31. PMC: 11025985. DOI: 10.1590/s1516-31802008000400008. View

Pacak K, Eisenhofer G, Ahlman H, Bornstein S, Gimenez-Roqueplo A, Grossman A . Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab. 2007; 3(2):92-102. DOI: 10.1038/ncpendmet0396. View

Adler J, Meyer-Rochow G, Chen H, Benn D, Robinson B, Sippel R . Pheochromocytoma: current approaches and future directions. Oncologist. 2008; 13(7):779-93. DOI: 10.1634/theoncologist.2008-0043. View

10.

Gupta A, Bains L, Agarwal M, Gupta R . Giant cystic pheochromocytoma: A silent entity. Urol Ann. 2016; 8(3):384-6. PMC: 4944640. DOI: 10.4103/0974-7796.184886. View

11.

Bravo E, Tagle R . Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev. 2003; 24(4):539-53. DOI: 10.1210/er.2002-0013. View

12.

Thompson L . Pheochromocytoma of the Adrenal gland Scaled Score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol. 2002; 26(5):551-66. DOI: 10.1097/00000478-200205000-00002. View

13.

Bae E, Ma S, Kim S, Kang H, Kim S . Renal artery compression by a huge pheochromocytoma. Korean J Intern Med. 2016; 31(3):622-3. PMC: 4855103. DOI: 10.3904/kjim.2015.222. View

14.

Maestroni U, Ziglioli F, Baciarello M, Bellini V, Dalla Valle R, Cataldo S . Multidisciplinary management of a large pheochromocytoma presenting with cardiogenic shock: a case report. BMC Urol. 2019; 19(1):118. PMC: 6868789. DOI: 10.1186/s12894-019-0554-5. View

15.

Lenders J, Eisenhofer G, Mannelli M, Pacak K . Phaeochromocytoma. Lancet. 2005; 366(9486):665-75. DOI: 10.1016/S0140-6736(05)67139-5. View