Swapnil Jadhav*, Prashant Gaikwad, Sagar Mane and Varun Mishra

Mahtma Gandhi Mission’s Medical College and Hospital Kamothe, Navi Mumbai, India

*Corresponding Author: Swapnil Jadhav, Mahtma Gandhi Mission’s Medical College and Hospital Kamothe, Navi Mumbai, India.

Received: August 08, 2025; Published: August 17, 2025

Abstract

Background: Pheochromocytomas are rare catecholamine-producing tumors that usually present with hypertension, headache, palpitations, and diaphoresis. Occasionally, they may remain clinically silent and be detected incidentally during imaging for unrelated complaints. Early identification is crucial, as timely surgical removal can prevent potentially fatal cardiovascular complications.

Case Presentation: A 63-year-old male presented with left-sided abdominal and back pain. Ultrasound revealed a large left suprarenal mass measuring 12.2 × 11.4 cm. CT abdomen suggested adrenal cortical carcinoma, but biochemical evaluation showed markedly elevated urinary normetanephrine (>10,000 μg/day) and metanephrine (3988.77 μg/day). PET-CT demonstrated increased metabolic activity confined to the adrenal lesion without metastasis. The patient underwent open adrenalectomy, and histopathology confirmed pheochromocytoma. Postoperatively, urinary catecholamine metabolite levels normalized, antihypertensive medications were discontinued, and the patient experienced significant weight loss.

Conclusion: Clinically silent pheochromocytomas can present as adrenal incidentalomas without classical symptoms, leading to diagnostic challenges. Biochemical screening should be performed in all cases of adrenal masses, regardless of symptomatology, to avoid missed diagnoses. Prompt recognition and surgical intervention result in excellent outcomes and prevent severe perioperative complications.

Keywords: Pheochromocytoma; Adrenal Incidentaloma; Clinically Silent Tumor; Catecholamines; Adrenalectomy; Hypertension; Normetanephrine; Metanephrine

References

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3. Kim BC., et al. “Silent pheochromocytoma in adrenal incidentaloma: unveiling clinical and radiological characteristics”. Annals of Surgical Treatment and Research1 (2024): 38-44.
4. Melmed S., et al. “Williams Textbook of Endocrinology (14^th, Chapter 16: Endocrine Hypertension)”. Philadelphia, PA: Elsevier (2020).
5. Kumar S., et al. “Massive Biochemically Silent Pheochromocytoma Masquerading as Nonfunctioning Adrenocortical Cancer”. JCEM Case Reports3 (2023): luad061.

Citation

Citation: Swapnil Jadhav., et al. “Clinically Silent Pheochromocytoma in Adrenal Incidentaloma: A Case Report" Acta Scientific Clinical Case Reports 6.9 (2025): 11-14.

Copyright

Copyright: © 2025 Swapnil Jadhav., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.