Journal List > J Korean Endocr Soc > v.24(3) > 1003498

Park, Kim, Roh, Song, Jung, Jung, Park, Kim, Mok, Kim, Kim, Kim, Byun, Suh, and Yoo: A Case of Improved Diabetes Mellitus After Removal of Nonfunctioning Adrenal Incidentaloma Diagnosed as Pheochromocytoma

Abstract

Pheochromocytoma not only decreases insulin secretion but also increases insulin resistance. One third of patients with pheochromocytoma have diabetes mellitus and their clinical prognosis showed improvement after surgery. Until now, those patients whose prognosis for diabetes mellitus improved after the operation of pheochromocytoma had typical characteristics such as hypertension, palpitation, headache and elevated hormones such as Vanillylmandelic acid, metanephrine, epinephrine and norepinephrine. We present the case of a 75-year-old woman with asymptomatic adrenal incidentaloma identified as pheochromocytoma which exhibited normal biochemical test results, and after removal of the abdominal mass, her severe hyperglycemia improved.

Figures and Tables

Fig. 1
Enhanced abdomen CT. A. Precontrast axial CT scan shows 4.7 × 4 cm sized well defined heterogeneous low density mass in right adrenal gland (arrow). B. In arterial phase, the mass is well enhanced and has central necrosis (arrow).
jkes-24-189-g001
Fig. 2
Histology findings. A. Cross section of the tumor shows a markedly variegated appearance with focal cystic change and hemorrhage. The tumor is encapsulated. B. On lower magnification, the tumor shows a solid growth pattern with a rich vascular network (×12.5, H&E stain). C. The tumor shows a small nesting pattern of growth with a 'zellballen' appearance (×400, H&E stain). D. Immunohistochemical staining of the tumor cells reveal diffuse and strong positivity for chromogranin (×200).
jkes-24-189-g002
Table 1
24 hr urine catecholamine of preoperation & postoperation
jkes-24-189-i001

VMA, vanillylmandelic acid.

Table 2
Serum Insulin and C-peptide level of preoperation & postoperation
jkes-24-189-i002

FB, fasting blood; 2PPB, 2hours post prandial blood.

References

1. Manger WM, Gifford RW Jr. Laragh JH, editor. Pheochromocytoma. Hypertension: Pathophysioloy, Diagnosis and Management. 1990. New York: Raven Press;1639–1659.
2. Melicow MM. One hundred cases of pheochromocytoma (107 tumors) at the Columbia-Presbyterian Medical Center, 1926-1976: a clinicopathological analysis. Cancer. 1977. 40:1987–2004.
3. Gifford RW Jr, Kvale WF, Maher FT, Roth GM, Priestly JT. Clinical features, diagnosis and treatment of pheochromocytoma: a review of 76 cases. Mayo Clinic Proc. 1964. 39:281–302.
4. Turnbull DM, Johnston DG, Alberti KG, Hall R. Hormonal and metabolic studies in a patient with a pheochromocytoma. J Clin Endocrinol Metab. 1980. 51:930–933.
5. Stenström G, Sjöström L, Smith U. Diabetes mellitus in phaeochromocytoma Fasting blood glucose levels before and after surgery in 60 patients with phaeochromocytoma. Acta Endocrinol (Copenh). 1984. 106:511–515.
6. Emmer M, Gorden P, Roth J. Diabetes in association with other endocrine disorders. Med Clin North Am. 1971. 55:1057–1064.
7. Young WF Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000. 29:159–185.
8. Song YJ, Jang LC, Yun HY, Cho WS, Oh TG, Park HP. Pheochromocytoma discovered incidentally on operation. Chungbuk Med J. 1996. 6:177–183.
9. Metz SA, Halter JB, Robertson RP. Induction of defective insulin secretion and impaired glucose tolerance by clonidine. Selective stimulation of metabolic alpha-adrenergic pathways. Diabetes. 1978. 27:554–562.
10. di Paolo S, de Pergola G, Cospite MR, Guastamacchia E, Cignarelli M, Balice A, Cospite MR, Nardelli GM, Giorgino R. Beta-adrenoreceptors desensitization may modulate catecholamine induced insulin resistance in human pheochromocytoma. Diabetes Metab. 1989. 15:409–415.
11. Rizza RA, Cryer PE, Haymond MW, Gerich JE. Adrenergic mechanisms for the effects of epinephrine on glucose production and clearance in man. J Clin Invest. 1980. 65:682–689.
12. La Batide-Alanore A, Chatellier G, Plouin PF. Diabetes as a marker of pheochromocytoma in hypertensive patients. J Hypertens. 2003. 21:1703–1707.
13. Hong CK, Ahn YB, Kim SH, Woo YS, Lee SG, Ko SH, Song HK, Yoon KH, Kang MI, Cha BY, Lee KW, Son HY, Kang SK. A case of cured diabetes mellitus after pheochromocytoma removal. J Korean Endocr Soc. 2001. 16:502–507.
14. Zianni D, Tzanela M, Klimopoulos S, Thalassinos NC. Symptomatic pheochromocytoma with normal urinary catecholamine metabolites. Hormones (Athens). 2004. 3:132–137.
15. Bravo EL. Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma. Endocr Rev. 1994. 15:356–368.
16. Sinclair D, Shenkin A, Lorimer AR. Normal catecholamine production in a patient with a paroxysmally secreting phaeochromocytoma. Ann Clin Biochem. 1991. 28:417–419.
17. Bravo EL, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev. 2003. 24:539–553.
18. Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P, Keiser HR, Goldstein DS, Eisenhofer G. Biochemical diagnosis of pheochromocytoma: which test is best? JAMA. 2002. 287:1427–1434.
19. Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007. 356:601–610.
20. Wiesner TD, Blüher M, Windgassen M, Paschke R. Improvement of insulin sensitivity after adrenalectomy in patients with pheochromocytoma. J Clin Endocrinol Metab. 2003. 88:3632–3636.
TOOLS
ORCID iDs

Chan Hee Jung
https://orcid.org/http://orcid.org/0000-0001-8988-0187

Similar articles