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Kim, Hwangbo, Kim, Choi, Seo, Lee, Kwak, Ku, Oh, Roh, Bae, Kim, Park, and Kim: Characterization of Incidentally Detected Adrenal Pheochromocytoma
Original Article
Endocrinology and Metabolism

Endocrinology and Metabolism 2012; 27(2): 132-137.

Published online: 20 June 2012

DOI: https://doi.org/10.3803/EnM.2012.27.2.132

Characterization of Incidentally Detected Adrenal Pheochromocytoma

Ye An Kim1, Yul Hwangbo1, Min Joo Kim1, Hyung Jin Choi1, Je Hyun Seo2, Yenna Lee1, Soo Heun Kwak1, Eu Jeong Ku1, Tae Jung Oh1, Eun Roh1, Jae Hyun Bae1, Jung Hee Kim1, Kyoung Soo Park1, Seong Yeon Kim1

1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

2Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Corresponding author: Seong Yeon Kim. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-3216, Fax: +82-2-762-9662, seongyk@plaza.snu.ac.kr

Received 25 January 2012       Accepted 23 April 2012

Copyright © 2012 Korean Endocrine Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In approach to an adrenal incidentaloma, early exclusion of pheochromocytoma is clinically important, due to the risk of catecholamine crisis. The aims of this study are to investigate the characteristics of incidentally detected pheochromocytomas, compared with that of the other adrenal incidentalomas, and to compare these characteristics with those of symptomatic pheochromocytomas.

Methods

In this retrospective study, we reviewed the medical records of 198 patients with adrenal incidentaloma from 2001 to 2010. We analyzed the clinical, laboratory and radiological data of pheochromocytomas, in comparison with those of the other adrenal incidentalomas. We also compared the characteristics of these incidentally detected pheochromocytomas with the medical records of 28 pathologically proven pheochromocytomas, diagnosed based on typical symptoms.

Results

Among the 198 patients with adrenal incidentaloma, nineteen patients were diagnosed with pheochromocytoma. Pheochromocytomas showed larger size and higher Hounsfield unit at precontrast computed tomography (CT) than did non-pheochromocytomas. All pheochromocytomas were larger than 2.0 cm, and the Hounsfield units were 19 or higher in precontrast CT. When both criteria of size > 2.0 cm and Hounsfield unit > 19 were met, the sensitivity and specificity for the diagnosis of pheochromocytoma were 100% and 79.3%, respectively. Compared with patients with pheochromocytoma, diagnosed based on typical symptoms, patients with incidentally detected pheochromocytoma were older, presented less often with hypertension, and showed lower levels of 24-hour urine metanephrine.

Conclusion

Adrenal incidentaloma with < 2.0 cm in size or ≤ 19 Hounsfield units in precontrast CT imaging was less likely to be a pheochromocytoma. Patients with incidentally discovered pheochromocytoma showed lower catecholamine metabolites, compared with those patients with symptomatic pheochromocytoma.

Keywords: Adrenal incidentaloma, Adrenocortical adenoma, Pheochromocytoma

Figures and Tables

Fig. 1
Receiver operating characteristic curve of attenuation values and size at precontrast computed tomography (CT) for adrenal pheochromocytoma.
enm-27-132-g001
Fig. 2
Scattergram of precontrast computed tomography attenuation values and sizes of pheochromocytomas and non-pheochromocytomas.
enm-27-132-g002
Table 1
Comparison between pheochromocytoma and non-pheochromocytoma in adrenal incidentaloma
enm-27-132-i001

*Mean ± standard deviation.

CT, computed tomography.

Table 2
Comparison between incidentally detected pheochrmocytoma and symptomatic pheochromocytoma
enm-27-132-i002

*Mean ± standard deviation; †Median (interquantile range).

VMA, vanillylmandelic acid; CT, computed tomography.

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