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Isolated Adrenal Mass in Patients with a History of Cancer: Remember Pheochromocytoma

Department of Surgery, Section of Endocrine Surgery, H4/750 Clinical Science Center, 600 Highland Avenue, University of Wisconsin, Madison, WI 53792, USA

Correspondence: Address correspondence and reprint requests to: Herbert Chen, MD, FACS; E-mail: chen{at}surgery.wisc.edu

Background: In a patient with a history of cancer, an isolated adrenal mass is usually thought to be a metastasis. Although a biochemical work-up to rule out pheochromocytoma is recommended, some question its practicality. This study was undertaken to determine the incidence of functional adrenal lesions in patients with a history of cancer and examine predictive factors for the type of lesion.

Methods: At a single institution, 33 patients with an isolated adrenal mass and a history of cancer underwent surgical treatment. Patients’ records were retrospectively analyzed for type of adrenal lesion and other diagnostic parameters.

Results: There were 20 males and 13 females with a mean age of 58±2 years. Of these, 20 (61%) had adrenal metastases, 8 (24%) had pheochromocytomas, and 5 (15%) had adrenal adenomas. Usual diagnostic criteria, including presenting symptoms, primary tumor, and other demographic characteristics, did not consistently predict the pathology of the lesion.

Conclusions: Nearly 1 in 4 resected adrenal masses in patients with a history of cancer were pheochromocytomas. The high incidence of pheochromocytoma in this series supports a thorough work-up, irrespective of previous cancer. Therefore, remember one thing in patients with an isolated adrenal mass and a history of cancer: pheochromocytoma.

Key Words: Pheochromocytoma • Adrenal mass • History of cancer • Incidentaloma

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