Ina Sorge (Leipzig)  

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13 Years  

Male  

Abdomen-Adrenals  

neoplastic  

13 year old boy, admission due to persisting headaches. Episodes of sweating for 2 months. Paleness and mild loss of weight, occasional palpitations.  

In 90% of the cases, a pheochromocytoma originates in the chromaffinic cells of the medulla of the suprarenal gland (as in our patient). In about 10% of the cases, the origin is the sympathetic trunk.

In our patient, epinephrine and norepinephrine was increased. Often in pheochromocytomas originating in the sympathetic trunk, only norepinephrine is increased.

Futher symptoms that were seen in our patient were: hyperglycemia & leucocytosis.

In young patients, a pheochromocytoma is often the first sign of a MEN-Syndrome (multiple endocrine neoplasia).  

<- view Ultrasound 1

Ultrasound 1: transversal: relatively homogenously round tumor. Not above, but rather ventromedial to the left kidney (but above the kidney hilus).




<- view Ultrasound 2

Ultrasound 2: No increased perfusion in the colored doppler ultrasound is seen. This finding is not typical for this diagnosis.




<- view MRI 1

MRI 1: T2-weighted, transversal: hyperintense, slightly inhomogenously round tumor, ventromedial to the left kidney (but above the kidney hilus) .




<- view MRI 2

MRI 2: T1-weigted without contrast media, sagittal: isointense- (centrally slightly inhomogenously hypointense). Tumor is ventromedial to the left kidney. After contrast media was given, an obvious contrast enhancement was seen (here without picture).

 

Surgery / Histo  

neuroblastoma, adrenal carcinoma, neurofibroma  

Surgery needed, good anesthesia is needed (because of the danger of a critical hypertonic crisis). Pre-treatment with alpha-receptor blockers, fluid substitution to normalize the plasma volume.  

The shown pheochromocytoma looked homogenous in the ultrasound examination and did not show hyperperfusion. Typically, smaller pheochromocytomas also have the tendency to show necrosis centrally. Hemorrhaging and calcifications (30%) are seen relatively often.  

N/A  

N/A  

Pheochromocytoma, Adrenal gland, Sympathetic trunk, hypertonic crisis, headaches, sweating, palpitations, weight loss, child, childhood, pediatric radiology  

Ina Sorge. Pheochromocytoma. PedRad [serial online] vol 3, no. 11.
URL: www.PedRad.info/?search=20031123165503