A dark cause of hypertension.

Aikaterini Theodoraki, Lavanta Farouk, Peter West, Tom Kurzawinski, Teng-Teng Chung, Stephanie Baldeweg, Chidambaram Nethaji, Penny Hyatt.

University College Hospital.


Objective: To present three patients with unexpectedly discovered adrenal masses who proved to have catecholamine secreting tumours.

Methods: Review of medical records and all investigations for three patients diagnosed with phaeochromocytomas in the context of incidentalomas in 2013 in a single centre.

Results: We discuss the presentation and investigations for three patients with unexpectedly discovered adrenal masses, who were diagnosed with phaeochromocytomas. All patients were known to be hypertensive, imaging characteristics showed lipid poor adrenal lesions, urine catecholamine metabolites were raised, and MIBG uptake was positive. In two patients the tumours were removed, and histology proved that they were phaeochromocytomas, and the third is waiting for adrenalectomy. Although all three patients had a previous history of hypertension on treatment, the adrenal masses were found on scanning done for other reasons. On further questioning all patients admitted to having had paroxysmal symptoms that could be related to catecholamine over-secretion.

Conclusion: Patients with incidentally discovered adrenal masses need to have testing in order to exclude the presence of a catecholamine secreting tumour, especially when imaging suggests a lipid-poor adenoma. Pheochromocytomas have a variable clinical presentation and careful history is required in order to elicit subtle features suggestive of catecholamine excess.