SAT-LB305 Concurrent Peri-Adrenal Paraganglioma and Renal AngiomyolipomaComplicated by Toxic Multinodular Goiter

Abstract

A 40 years old woman presented with headache, palpitation and diaphoresis by the past 3 months, and then developed progressive dyspnea on exertion and chest pain 2 weeks ago. She also lost 5 kg of her body weight during the past 6 months. She ever had multinodular goiter and lobectomy was done 12 years ago, after that she lost to follow up. At meantime, toxic multinodular goiter was suspected and high level of free T4, T3, and suppressed thyrotropin were demonstrated. Furthermore, thyroid scan revealed heterogenous tracer uptake at her thyroid bed. Methimazole was started, however her blood pressure and heart rate were all uncontrolled. Pheochromocytoma was suspected and markedly elevated of both urinary normetanephrine and metanephrine were confirmed. Computed tomogram revealed a huge, right supra-renal mass. In addition, hypodensity mass were found at upper pole of right kidney, and the results of 131I-Metaiodobenzylguanidine scintigraphy showed increased tracer uptake at upper abdomen. Right adrenalectomy and partial nephrectomy were performed. The final pathological diagnosis was sympathetic paraganglioma, and angiomyolipoma which confirmed by immunohistochemical staining. We present here an unusual case of concurrent periadrenal paraganglioma and renal angiomyolipoma which was complicated by autonomous toxic multinodular goiter.