Journal List > J Korean Diabetes Assoc > v.31(6) > 1062482

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Cho, Kim, Kim, Hah, Kim, Kim, Park, Kim, and Kwon: A Case of Cured Diabetes Mellitus after Occult Malignant Pheochromocytoma Removal
Case Report
The Journal of Korean Diabetes Association

The Journal of Korean Diabetes Association 2007; 31(6): 520-524.

Published online: 30 November 2007

DOI: https://doi.org/10.4093/jkda.2007.31.6.520

A Case of Cured Diabetes Mellitus after Occult Malignant Pheochromocytoma Removal

Ho-Chan Cho, Hye-Soon Kim, Yoon-Jung Kim, Yu-Jin Hah, Nam-Keong Kim, Mi-Kyung Kim, Keun-Gyu Park, Yong-Hoon Kim1, Sun-Young Kwon2

Department of Internal Medicine, Keimyung University School of Medicine, Korea.

1Department of Surgery, Keimyung University School of Medicine, Korea.

2Department of Pathology, Keimyung University School of Medicine, Korea.

Received 19 October 2007       Accepted 16 November 2007

Copyright © 2007 Korean Diabetes Association

Abstract

Pheochromocytoma is characterized by a combination of various clinical manifestations that include the classic triad of severe headache, palpitations and diaphoresis. In addition, hyperglycemia can be caused by overproduction of catecholamines, which are secreted by a catecholamine-secreting neoplasm of adrenal or extra-adrenal chromaffin tissue. We encountered a case of diabetes with an occult malignant adrenal pheochromocytoma, who did not have any classic manifestations. A 37-year-old male was admitted because of polydipsia, polyuria, and weight loss. Fasting blood glucose level was 497 mg/dL, hemoglobin A1c level was 15%, and diabetic retinopathy and peripheral polyneuropathy were also accompanied. Incidentally, right adrenal mass was detected by ultrasonography of abdomen. Urinary excretion of total metanephrine and epinephrine were elevated. Adrenal CT showed a 7.1 cm sized right adrenal cystic mass with enhancing solid portion and hemorrhagic content. The scan with 123I-MIBG revealed the cystic mass with increased rim uptake in the region of right adrenal gland. After removal of the tumor, the increased levels of catecholamine were normalized. Moreover, blood glucose level was normalized without administration of insulin or oral hypoglycemic agents. The pathologic examination showed that the neoplasm was a malignant adrenal pheochromocytoma. We report this case that diabetes was cured after removal of malignant tumor with literature review at first in Korea.

Keywords: Epinephrine, Hyperglycemia, Malignant pheochromocytoma

Figures and Tables

Fig. 1
Abdominal USG shows 58 × 59 mm sized mass in the right suprarenal area.
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Fig. 2
Abdominal CT shows 71 × 63 mm sized cystic mass with enhancing solid portion and hemorrhagic content in right adrenal area.
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Fig. 3
123I-MIBG scan shows a cystic mass with increased rim uptake, especially posterolateral portion in the right adrenal area.
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Fig. 4
Gross findings show an ovoid, pale pink to red and cystic mass from right adrenal gland, measuring 70 × 75 × 68 mm in size and weighing 162.0 gm. There is a remaining adrenal gland tissue on the surface of the cystic mass. On opening the specimen, dark bloody fluid was expelled. The cystic wall of the specimen shows edematous change and thickened. Thickness of the cystic wall measures 1.3 cm in the maximum thickness. There are several pale tan, nodular mural nodules on the inner cystic wall.
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Fig. 5
A. Microscopic findings show atypical tumor cells nests forming vague zellballen area (H&E stain, ×100). B. Tumor cell have profound nuclear pleomorphism with giant cells formation and there are scattered atypical mitotic figures with prominent nucleoli in tumor cells (H&E stain, ×400). C. Tumor cells are focally infiltrative growth pattern into the surrounding capsule, but there is no definite evidence of lympho-vascular invasion in the tumor mass (H&E stain, ×40).
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