Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 4, Number 11, November 2013, pages 753-757

Cystic Pheochromocytoma Discovered as an Adrenal Incidentaloma


Figure 1.
Figure 1. Abdominal CT scan in the axial plane (a) and coronal reconstitution (b). The images show a round cystic lesion with an enhanced thick wall, approximately 4 cm in diameter, in the right adrenal gland.
Figure 2.
Figure 2. 123I-MIBG scintigraphy images from an anterior view (a) and a posterior view (b), obtained 24 hours after the injection of 123I-MIBG, show a ring-accumulated lesion in the right adrenal gland.
Figure 3.
Figure 3. A bisected surgical specimen shows a well-circumscribed mass with a central cystic space containing hemorrhagic fluid and a hemorrhagic thick wall.


Table 1. Laboratory Data
UrinalysisBlood chemistry
  Protein(-)  TP6.7g/dL  Na141mEq/L
  Glucose(-)  Alb4.2g/dL  K3.9mEq/L
  Ketone(-)  T-Bil1mg/dL  Cl105mEq/L
  OB(-)  AST17IU/L  Ca9.8mg/dL
CBC  ALT22IU/L  P3.5mg/dL
  WBC4,750/mL  LDH139IU/L  TG61mg/dL
  RBC456 × 104/mL  ALP277IU/L  HDL-C100mg/dL
  Hb13.4g/dL  g-GTP29IU/L  LDL-C156mg/dL
  Hct43%  BUN13.4mg/dL  FPG124mg/dL
  MCV94.3fL  Cr0.59mg/dL  HbA1c6%
  MCH29.4pg  UA4.6mg/dL
  MCHC31.2g/dL  CRP0.02mg/dL
  Plt21.8 × 104/mL


Table 2. Endocrinological Data
VMA: vanillylmandelic acid; PRA: plasma rennin activity; PAC: plasma aldosterone concentration; DHEA-S:dehydroepiandrosterone.
  Epinephrine0.54ng/mL  TSH0.665mIU/mL
  Norepinephrine2.72ng/mL  FT33.08pg/mL
  Dopamine0.22ng/mL  FT41ng/dL
  Epinephrine169.3mg/24h  PAC145pg/mL
  Norepinephrine697.8mg/24h  ACTH20.9pg/mL
  Dopamine1,554.50mg/24h  Cortisol14mg/dL
  Metanephrine1.31mg/24h  DHEA-S888ng/mL
  Normetanephrine1.55mg/24h  Calcitonin14pg/mL
  VMA9.84mg/24h  PTH-intact39pg/mL