Biochemically Negative Pheochromocytoma With Spontaneous Hemorrhage

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Pheochromocytomas, neuroendocrine tumors producing excess catecholamines, comprise ~4.2% of incidental adrenal masses.
• Advancements in imaging increase incidental adrenal mass discovery, necessitating clear diagnostic pathways.

Observation:

• A 31-year-old female presented with abdominal pain and an adrenal mass.
• Multiple biopsy attempts preceded biochemical evaluation of the adrenal mass.
• The mass was diagnosed as a biochemically negative pheochromocytoma with spontaneous hemorrhage post-resection.

Findings:

• Pheochromocytomas are the most frequent adrenal masses with spontaneous hemorrhage.
• 9-32% of pheochromocytomas can be biochemically silent, complicating diagnosis.
• Spontaneous hemorrhage occurred in a biochemically negative pheochromocytoma.

Implications:

• This case emphasizes diagnostic challenges in pheochromocytoma with hemorrhage.
• It highlights the need for caution with adrenal masses, considering silent pheochromocytomas.
• Pre-procedural biochemical evaluation is crucial for all adrenal masses.