• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Right Adrenal Pheochromocytoma and a 3mm Lesion On the Left Adrenal Gland. How to Approach?

Venkata S Kanthimathinathan, MD, Camila Manrique Acevedo, MD, Arthur Rawlings, MD. University of Missouri Health Care

 

Introduction:
Diagnosis of bilateral adrenal mass in any patient presents a management dilemma. We report an unusual case of a 51 year old female with 4.8 cm right adrenal pheochromocytoma and a 3 mm left adrenal lesion. Despite extensive work-up including blood, urine, CT scan, MRI, MIBG scan, we were unable to reach a definitive diagnosis on the left adrenal lesion. We performed laparoscopic right adrenalectomy for the right adrenal tumor. One month postoperative blood and urine work up revealed normal metanephrines. As there is no evidence of hormonally active tumor, we are observing the left adrenal lesion with biochemical and radiological investigations.

Case report:
51 year old Caucasian female with history of ulcerative colitis, referred to General surgery for evaluation of enlarging right adrenal mass. Mass was detected 6 years ago through CT scan done for GI symptoms. No further follow-up was done until this time. Patient reports intermittent bilateral flank pain, night sweats, and palpitations. Physical examination was unremarkable.

Pertinent laboratory values include elevated urine metanephrine (1555), urine normetanephrine (262), serum normetanephrine (1.22) and serum metanephrine (5.82). She has normal aldosterone, renin, ACTH, DHEA and 24 hour urine cortisol levels.

Radiological investigations include CT scan of the abdomen and pelvis with IV contrast, MRI abdomen and MIBG scintigraphy with SPECT/CT scan. CT scan showed a 3.3 X 2.9 cm right adrenal mass that appears to be of soft tissue density with enhancement and rapid washout, suggestive of a pheochromocytoma. CT also showed a prominent cavernous hemangioma and a very subtle area of atypical density in the left adrenal gland that measures approximately 3 mm in size, relatively nonspecific in appearance. MRI confirmed CT scan findings. MIBG scan showed a large focus of increased uptake corresponding to a right adrenal mass on SPECT CT images and a small focus of increased uptake corresponding to the normal sized left adrenal gland.

Patient was diagnosed with right adrenal pheochromocytoma and a non specific 3 mm lesion in the left adrenal gland. As the lesion on the left adrenal gland was too small to characterize, we performed a laparoscopic right adrenalectomy. Her surgery and postoperative course were uneventful and she was discharged on postoperative day 2. Pathology showed a 4.8 cm right adrenal pheochromocytoma with margins free of tumor. Repeat blood and urine work up one month after surgery revealed normal urine metanephrine, normetanephrine, serum metanephrine and normetanephrine. However, genetic testing returned SDHB mutation positive putting the patient at high risk for malignant disease and extra-adrenal tumors. As there is no evidence of hormonally active tumor, we are currently observing the left adrenal lesion with biochemical and radiological investigations.
 


Session Number: Poster – Poster Presentations
Program Number: P603
View Poster

898

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons