Atypical Presentation of Giant Pheochromocytoma Managed With Minimally Invasive Surgery

Giant pheochromocytomas are rare tumors, typically exceeding 7 cm in size. Most are noncatecholamine secreting due to tumor necrosis and connective tissue content. Their presentation can range from classic hyperadrenergic symptoms to vague gastrointestinal complaints. Larger tumors are associated with higher risks of metastasis, mortality, and perioperative complications. Our case presents a 31-year-old female who presented with the chief complaint of vomiting, associated with intermittent palpitations and elevated blood pressure, with subsequent imaging revealing an 8.7 cm right adrenal mass. Complete resection of the mass showed a 10 × 7 × 3.9 cm mass that occupied the entire adrenal medulla, consistent with a giant pheochromocytoma. This case contributes to the evidence supporting a minimally invasive approach as well as individualized management of giant pheochromocytomas. Furthermore, it emphasizes the importance of a high clinical suspicion in the context of vague symptoms.