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• W2553419173 abstract "Pheochromocytoma is a diverse entity with variable clinical manifestations and sometimes atypical laboratory and imaging findings. Cystic pheochromocytoma, as reported by Yamagata and colleagues (1.Yamagata S. Kageyama K. Nomura A. et al.A case of cystic pheochromocytoma with hypertension and headaches mimicking a large pancreatic cystic tumor.AACE Clin Case Rep. 2017; 3: 129-133Abstract Full Text Full Text PDF Scopus (2) Google Scholar), is an exceedingly rare variant of pheochromocytoma of the adrenal gland. It is understandable how it could be difficult to distinguish a cystic mass of the left adrenal gland from a cystic pancreatic mass given the proximity of the 2 structures. The left adrenal lies immediately posterior to the body and tail of the pancreas and in close proximity to the spleen and posterior wall of the stomach. Laparoscopic exposure of the left adrenal gland is obtained by anteromedial mobilization of the spleen and pancreas. We have reported a subdiaphragmatic bronchogenic cyst arising from the posterior wall of the stomach (also in close proximity to the left adrenal gland) and a retroperitoneal cystic teratoma, both of which masqueraded as adrenal incidentalomas (2.Hedayati N. Cai D.X. McHenry C.R. Subdiaphragmatic bronchogenic cyst masquerading as an “adrenal incidentaloma”.J Gastrointest Surg. 2003; 7: 802-804Crossref PubMed Scopus (27) Google Scholar,3.Chen J.C. Khiyami A. McHenry C.R. Retroperitoneal cystic teratoma masquerading as an incidentally discovered adrenal mass.Endocr Pract. 2011; 17: e130-e134Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar). Other entities that have been reported to masquerade as primary adrenal tumors include lymphoma and sarcoma arising from the soft tissues of the retroperitoneum, and Castleman disease, a benign proliferation of lymphoid tissue (4.Carnat T. Mai K.T. Burns B.F. Peri-adrenal malignant lymphoma masquerading as adrenal cortical neoplasm.Pathology. 2004; 36: 278-279Abstract Full Text PDF PubMed Scopus (2) Google Scholar). A high index of suspicion is often required for diagnosis of pheochromocytoma since classic features and manifestations may be absent. An important clue that the cystic mass in the patient of Yamagata and colleagues (1.Yamagata S. Kageyama K. Nomura A. et al.A case of cystic pheochromocytoma with hypertension and headaches mimicking a large pancreatic cystic tumor.AACE Clin Case Rep. 2017; 3: 129-133Abstract Full Text Full Text PDF Scopus (2) Google Scholar) was of adrenal rather than of pancreatic origin was the fact that the left adrenal gland could not be visualized. Classically, patients with a pheochromocytoma present with severe paroxysmal or persistent hypertension, headache, palpitations, diaphoresis, and a solid adrenal or extra-adrenal mass. The diagnosis is established by elevated plasma fractionated metanephrines or elevated 24-hour urinary fractionated metanephrines. Because of the rarity of pheochromocytoma, the variability of presentation is often underappreciated. In my own experience operating on 27 patients with pheochromocytoma, 19 (70%) had an incidentally discovered tumor, 6 (22%) were normotensive, and 2 (7%) had near normal urinary metanephrine levels (unpublished data). It is not uncommon for patients to be asymptomatic. Failure to consider a diagnosis of pheochromocytoma can lead to an ill-advised biopsy, which occurred at an outside hospital in 4 of our patients before they were referred to our institution (unpublished data). The case report by Yamagata and colleagues (1.Yamagata S. Kageyama K. Nomura A. et al.A case of cystic pheochromocytoma with hypertension and headaches mimicking a large pancreatic cystic tumor.AACE Clin Case Rep. 2017; 3: 129-133Abstract Full Text Full Text PDF Scopus (2) Google Scholar) reinforces that a mass in the adrenal gland can be confused with other visceral masses, just as masses in other viscera or the soft tissues of the retroperitoneum may masquerade as an adrenal tumor. The adrenal gland should always be considered as a potential source of a retroperitoneal mass. Furthermore, a pheochromocytoma often manifests in an atypical fashion, and a high index of suspicion is required to make a diagnosis. The authors have no multiplicity of interest to disclose." @default.
• W2553419173 created "2016-11-30" @default.
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• W2553419173 date "2017-01-01" @default.
• W2553419173 modified "2023-10-17" @default.
• W2553419173 title "Pheochromocytoma: A Clinical Enigma" @default.
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