Case Report
Failure to Diagnose Phaeochromocytoma Preoperatively: A Case Report and Review of Diagnostic Criteria
Table 1
Diagnostic tests performed.
| | Imaging studies | | Modality | Timing | Result |
| | Ultrasound scan | Day 0 | cm mass upper pole of left kidney | | CT scan | Day 0 | cm L retroperitoneal mass suggestive of haemorrhage into adrenal cyst | | CT scan | At 2 months |
Decrease in size to cm suggestive of adrenal vascular tumour | | CT angiogram | At 2 months |
Vascular L adrenal tumour | | CT angiogram | At 6 months |
Further decrease in size to cm, with the appearance of a vascular adrenal tumour | | MRI | At 8 months |
Adrenal mass cm. Not a simple adenoma |
| | Biochemical studies | | Test | Timing | Result | Normal range |
| | Random serum cortisol (mmol · L−1) | Day 1 | 489 | 140–690 | | Random serum cortisol (mmol · L−1) | Day 1 (repeat) | 362 | 140–690 | | Serum Aldosterone (pmol · L−1) | Day 1 | 129 | 111–860 | | Serum Renin (mU · L−1) | Day 1 | 20 | 8.3–46.3 | | 24-hour urinary catecholamines | | Noradrenaline (nmol/24-hour) | At 2 months | 266 | 0–430 | | Adrenaline (nmol/24-hour) | At 2 months | 41 | 0–70 | | Dopamine (nmol/24-hour) | At 2 months | 1690 | 0–2700 n | | 24-hour urinary metanephrines | | Normetadrenaline (nmol/24-hour) | At 2 months | 2972 | 0–4900 | | Metadrenaline (nmol/24-hour) | At 2 months | 1293 | 0–2000 | | 24-hour urinary catecholamines | | Noradrenaline (nmol/24-hour) | At 9 months | 313 | 0–430 | | Adrenaline (nmol/24-hour) | At 9 months | 53 | 0–70 | | Dopamine (nmol/24-hour) | At 9 months | 1480 | 0–2700 | | 24-hour urinary catecholamines | | Noradrenaline (nmol/24-hour) | At 18 months | 133 | 0–430 | | Adrenaline (nmol/24-hour) | At 18 months | 35 | 0–70 | | Dopamine (nmol/24-hour) | At 18 months | 783 | 0–2700 |
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24-hour urinary catecholamines collected on the day of surgery following the hypertensive crisis were also normal.
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