A CASE OF PHEOCHROMOCYTOMA RECURRING 10 YEARS AFTER THE RESECTION OF RIGHT ADRENAL PHEOCHROMOCYTOMA

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  • Suzuki Toru
    Department of Urology, Faculty of Medicine, The University of Tokyo
  • Mori Chuzo
    Department of Urology, Faculty of Medicine, The University of Tokyo
  • Umeda Takashi
    Department of Urology, Faculty of Medicine, The University of Tokyo
  • Kawabe Kazuki
    Department of Urology, Faculty of Medicine, The University of Tokyo
  • Ueno Akira
    Department of Urology, Faculty of Medicine, The University of Tokyo
  • Koiso Kenkichi
    Department of Urology, Faculty of Medicine, The University of Tokyo
  • Niijima Tadao
    Department of Urology, Faculty of Medicine, The University of Tokyo

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Other Title
  • 右副腎褐色細胞腫摘除10年後に再発した褐色細胞腫の1例
  • ウフクジン カッショク サイボウシュ テキジョ 10ネンゴ ニ サイハツシタ

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Abstract

A case of pheochromocytoma (left adrenal and para-aortic pheochromocytoma) recurring 10 years after the first resection of right adrenal pheochromocytoma was reported.<br>A 22-year-old male was transferred to our hospital due to dyspnea, epistaxis and hypertension (210/160). He had the history of right adrenal pheochromocytoma (28.5g) that had been resected in our hospital, at his age of 12. Gastrojejunostomy was successfully performed due to duodenal stricture owing to ulcerative scar formation 4 years after the first operation. Owing to his high value of urinary catecholamine excretion (norepinephrine; 23, 020μg/day, epinephrine; 7μg/day), recurrent pheochromocytoma was suspected.<br>Routine laboratory studies revealed a high fasting blood glucose level, high erythrocyte sedimentation rate, leucocytosis, 4+ serum C-reactive protein, and proteinuria. Endocrinological studies showed normal thyroid and adrenal cortical function. Basal metabolic rate (+41.5%) and plasma renin activity (17.3ng/ml/h) were elevated. Computerized tomography showed 2 masses located on the left adrenal gland and in the right renal hilar region. Two tumors (110g, 20g) were successfully resected through the trans-abdominal approach. Both tumors showed the same histological features as the previously resected pheochromocytoma and no vascular invation and/or capscular invasion.<br>Recurrent benign pheochromocytoma may be defined as follows.<br>1. It is not metastasis of the tumors.<br>2. It is not an apparent remnant of synchronous multiple pheochromocytoma.<br>3. There exists a certain period in which its subjective and/or objective symptoms are free.<br>In the Japanese literature, 3 such cases including this case which are consistent with the above definition have been reported. All 3 patients are male, under 25 years old. The period of recurrence ranges from 7 to 13 years.<br>In general, juvenile pheochromocytoma has the tendency of being multiple synchronously and/or metachronously. Considering the fact the number of operated juvenile pheochromocytoma has been increasing in Japan, careful follow-up should be carried out to detect a recurrent pheochromocytoma as early as possible.

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