Introduction
Adrenal incidentaloma (AI) is a result of easy availability of imagiological diagnostic techniques and may include many primary, metastatic, benign, and malignant entities, the majority of which are benign and nonfunctioning adrenal adenomas. However to 7% prove to be pheochromocytomas.
Case Report
38 year old male with right adrenal adenoma associated co-morbidity was pre-diabetic without symptoms suggesting pheochromocytoma, biochemically with a borderline increase on urinary norepinephrine. He was proposed for laparoscopic right adrenalectomy with no preoperative pharmacological preparation. Intra operatively, the tumor manipulation resulted in manifestations typical of pheochromocytoma, refractory to treatment, with biochemical signs of myocardial ischemia.
Discussion
Usual recommendations are on favor of measuring plasma and urinary fractionated metanephrines in all patients with adrenal incidentaloma, this evaluation should be complemented with imagiological findings. There is no universal consensus on when to start preoperative preparation, in which patients or which pharmacological scheme should be used.
Conclusion
Based upon ours and reported experience, we recommend that every asymptomatic patient with adrenal mass and biochemical evaluation suggestive of pheochromocytoma should be preoperatively submitted to alpha-antagonism to avoid potentially life threatening hemodynamic fluctuations on intraoperative and postoperative period
Author(s): Rita Araujo*, Celine Marques, Mariana Rodrigues, Ana Paulino, and Campos Luis