Journal of the Chinese Medical Association
Volume 70, Issue 7 , Pages 289-293, July 2007

Pheochromocytoma and Adrenocortical Adenoma in the Same Gland

  • Wei-Ren Hwang

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Wen-Ya Ma

      Affiliations

    • Tauyuan Veterans Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • An-Li Tso

      Affiliations

    • Wei Gong Memorial Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Chin-Chen Pan

      Affiliations

    • Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Yen-Hwa Chang

      Affiliations

    • Division of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Hong-Da Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Hong-Da Lin, Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 22 January 2007; accepted 1 June 2007.

Article Outline

A right adrenal tumor was found incidentally during abdominal computed tomography exam in a 51-year-old female patient, who had had diabetes and hypertension for more than 10 years. The computed tomography scan was arranged for possible pancreatic lesion by a neurologist. Norepinephrine level was high in the plasma and urine. Vanillylmandelic acid level was elevated in the urine. Diurnal cortisol rhythm, plasma adrenocorticotropic hormone and urine free cortisol were all normal, but the plasma cortisol concentration could not be suppressed after a standard low-dose dexamethasone suppression test. Therefore, adrenal cortical adenoma with subclinical Cushing's syndrome was highly suspected; however, further imaging studies, including magnetic resonance image and 131I-6β-iodomethylnorcholesterol adrenal scintigraphy failed to discriminate an additional tumor. After right adrenalectomy, a small adrenal cortical adenoma and a large pheochromocytoma were noted. This is an extremely rare case of an adrenal incidentaloma consisting of both medullary and cortical tumors in the same gland.

Key Words:  cortical adenoma , pheochromocytoma , subclinical Cushing's syndrome

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References 

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PII: S1726-4901(07)70007-2

doi:10.1016/S1726-4901(07)70007-2

Journal of the Chinese Medical Association
Volume 70, Issue 7 , Pages 289-293, July 2007

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