English

Abstract

INTRODUCTION: Adrenal masses discovered by imaging techniques for reasons unrelated to adrenal diseases are documented as incidentalomas with pheochromocytoma accounting for about 20% of adrenal masses. Clinically silent, biochemically negative Pheochromocytomas are rare. Close intra and postoperative monitoring is the key to success while operating on a mass lesion in suprarenal area. CASE REPORT: A 38 years female patient presented with dull aching pain & lump in left hypochondrium and left lumbar region of four months duration. Patient was normotensive and did not have any comorbid conditions. Abdominal examination revealed a smooth surfaced, firm, ballotable lump of 14 X 10 cm in the left lumbar region. Adrenal function tests including urinary and plasma catecholamines and metanephrine were within normal limits. CT scan of abdomen revealed a left retroperitoneal mass arising from left adrenal gland of benign nature. Left adrenalctomy was performed. Per operatively patient had unexpected hypertensive episode which was managed. Histopathological examination was reported as Benign Pheochromocytoma. CONCLUSION: Clinically silent pheochromocytoma is a rare condition and with normal catecholamines and metanephrines is even rarer. Possibility of pheochromocytoma should be kept in mind while operating on a mass in the suprarenal region even in a normotensive patient with normal hormonal parameters so that operating team can deal with an unexpected hypertensive crisis. Adrenalectomy should be done for such patients because of concern of malignant transformation and or development of subsequent functional abnormality.