Bernini GP, Vivaldi MS, Argenio GF, Moretti A, Sgro M, Brogi
G, Salvetti A
Frequency of pheochromocytoma in adrenal incidentalomas and
utility of glucagon test for the diagnosis
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:89A 1996
Incidental adrenal tumors, which occur pathologically in up to 8% of patients
and by CT scan in
about 0.4% of CT scans (Herrera et al, Surgery, 110:1014, 1991), are an oft
encountered diagnostic
problem. One must exclude both malignancy and an occult endocrine producing
tumor, such as
pheochromocytoma. About 1/3 of pheochromocytomas are diagnosed incidentally
at either laparoscopy
or by CT scan.
In this abstract, 89 patients with adrenal incidentalomas were studied, about
2/3 or whom were
normotensive. It is stated that 6 patients were diagnosed to have
pheochromocytoma on the basis of
"humoral elevations" or by surgery. Of these, 3 had elevated plasma
norepinephrine levels (>600
pg/ml), 4 had elevated plasma adrenaline levels (> 80 pg/ml), and 4 had a
positive glucagon
stimulation test (plasma adrenaline > 2000 pg/ml). The conclusion is, that
adrenal incidentalomas
are not rarely due to pheochromocytomas.
Comment: One would like to be sure that all 6 patients did indeed have
pheochromocytoma.
This seems to be an inordinately high percentage of patients with pheo, but,
this is precisely the
authors' message. It is unclear how the patients were selected, however, and
how large the adrenal
tumors were.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
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11th Scientific Meeting, American Society of Hypertension
H: Special problems :
Pheochromocytoma