Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma
BackgroundGiant cystic pheochromocytoma and giant adrenal myelolipoma are two highly uncommon masses. There are difficulties in diagnosis and management of both types of giant (>20 cm) adrenal tumors.Case 1A 56-year-old male patient applied with complaints of headache and high blood pressure....
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Frontiers Media S.A.
2025-03-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1541880/full |
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| author | Ali Hakan Konuş Kader Uğur Erhan Aygen Cihat Tektaş Fatih Durumlu Muhammet Çalık |
| author_facet | Ali Hakan Konuş Kader Uğur Erhan Aygen Cihat Tektaş Fatih Durumlu Muhammet Çalık |
| author_sort | Ali Hakan Konuş |
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| description | BackgroundGiant cystic pheochromocytoma and giant adrenal myelolipoma are two highly uncommon masses. There are difficulties in diagnosis and management of both types of giant (>20 cm) adrenal tumors.Case 1A 56-year-old male patient applied with complaints of headache and high blood pressure. A mass was palpated in the left upper quadrant. The average 24-hour ambulatory blood pressure was 146/93 mm Hg. Computed tomography revealed a huge left adrenal cystic mass measuring 22 × 17 cm. A large left renal parapelvic cyst measuring 6 × 5.5 cm was also observed. Urine metanephrine and normetanephrine values were high. The patient was diagnosed with pheochromocytoma. It was decided to remove the adrenal cystic mass and renal parapelvic cyst with open surgery. Severe hypotension occurred during the intraoperative and early postoperative periods, and severe orthostatic dizziness occurred during the in-hospital stay and two months of outpatient follow-up. The patient's urine metanephrine and normetanephrine levels returned to normal. The average 24 h ambulatory blood pressure was 122/69 at six months.Case 2A 53-year-old male patient was admitted with complaints of high blood pressure, accompanied by mild headache and dizziness that had been ongoing for several months. A mass was palpated in the right upper quadrant. The average 24 h ambulatory blood pressure was 151/91 mm Hg. Abdominal computed tomography revealed a 24 × 16 × 22 cm solid mass with diffuse fat density originating from the right adrenal gland. Laboratory studies and endocrine investigations were normal. With the diagnosis of adrenal myelolipoma, a mass weighing 4,229 g was surgically removed. The patient was normotensive without medical treatment during the two-year follow-up after the operation.ConclusionTo our knowledge, our case of giant cystic pheochromocytoma accompanied by ipsilateral large renal parapelvic cyst, which is the first in the literature, reports the management of severe hypotension in the perioperative period and severe orthostatic dizziness in the two-month follow-up. Non-functional adrenal myelolipomas can cause hypertension with mass effect. Our second case is one of the largest adrenal myelolipomas in literature. Although surgical removal of giant masses is difficult, successful surgeries have resulted in resolution of hypertension in our cases at mid-term follow-up. |
| format | Article |
| id | doaj-art-daf4bcdaee264b63ac0548e40d267e43 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-03-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-daf4bcdaee264b63ac0548e40d267e432025-08-20T02:02:13ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-03-011210.3389/fcvm.2025.15418801541880Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipomaAli Hakan Konuş0Kader Uğur1Erhan Aygen2Cihat Tektaş3Fatih Durumlu4Muhammet Çalık5Department of Cardiology, Bingöl State Hospital, Bingöl, TürkiyeDepartment of Endocrinology, Faculty of Medicine, Fırat University, Elazığ, TürkiyeDepartment of General Surgery, Faculty of Medicine, Fırat University, Elazığ, TürkiyeDepartment of Urology, Bingöl State Hospital, Bingöl, TürkiyeDepartment of Radiology, Bingöl State Hospital, Bingöl, TürkiyeDepartment of Pathology, Faculty of Medicine, Fırat University, Elazığ, TürkiyeBackgroundGiant cystic pheochromocytoma and giant adrenal myelolipoma are two highly uncommon masses. There are difficulties in diagnosis and management of both types of giant (>20 cm) adrenal tumors.Case 1A 56-year-old male patient applied with complaints of headache and high blood pressure. A mass was palpated in the left upper quadrant. The average 24-hour ambulatory blood pressure was 146/93 mm Hg. Computed tomography revealed a huge left adrenal cystic mass measuring 22 × 17 cm. A large left renal parapelvic cyst measuring 6 × 5.5 cm was also observed. Urine metanephrine and normetanephrine values were high. The patient was diagnosed with pheochromocytoma. It was decided to remove the adrenal cystic mass and renal parapelvic cyst with open surgery. Severe hypotension occurred during the intraoperative and early postoperative periods, and severe orthostatic dizziness occurred during the in-hospital stay and two months of outpatient follow-up. The patient's urine metanephrine and normetanephrine levels returned to normal. The average 24 h ambulatory blood pressure was 122/69 at six months.Case 2A 53-year-old male patient was admitted with complaints of high blood pressure, accompanied by mild headache and dizziness that had been ongoing for several months. A mass was palpated in the right upper quadrant. The average 24 h ambulatory blood pressure was 151/91 mm Hg. Abdominal computed tomography revealed a 24 × 16 × 22 cm solid mass with diffuse fat density originating from the right adrenal gland. Laboratory studies and endocrine investigations were normal. With the diagnosis of adrenal myelolipoma, a mass weighing 4,229 g was surgically removed. The patient was normotensive without medical treatment during the two-year follow-up after the operation.ConclusionTo our knowledge, our case of giant cystic pheochromocytoma accompanied by ipsilateral large renal parapelvic cyst, which is the first in the literature, reports the management of severe hypotension in the perioperative period and severe orthostatic dizziness in the two-month follow-up. Non-functional adrenal myelolipomas can cause hypertension with mass effect. Our second case is one of the largest adrenal myelolipomas in literature. Although surgical removal of giant masses is difficult, successful surgeries have resulted in resolution of hypertension in our cases at mid-term follow-up.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1541880/fullgiant cystic pheochromocytomagiant adrenal myelolipomaadrenal tumorlarge renal parapelvic cysthypertensionorthostatic dizziness |
| spellingShingle | Ali Hakan Konuş Kader Uğur Erhan Aygen Cihat Tektaş Fatih Durumlu Muhammet Çalık Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma Frontiers in Cardiovascular Medicine giant cystic pheochromocytoma giant adrenal myelolipoma adrenal tumor large renal parapelvic cyst hypertension orthostatic dizziness |
| title | Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma |
| title_full | Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma |
| title_fullStr | Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma |
| title_full_unstemmed | Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma |
| title_short | Case Report: Two highly unusual adrenal tumors presenting with hypertension: a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma |
| title_sort | case report two highly unusual adrenal tumors presenting with hypertension a giant cystic pheochromocytoma with an ipsilateral large renal parapelvic cyst and a giant adrenal myelolipoma |
| topic | giant cystic pheochromocytoma giant adrenal myelolipoma adrenal tumor large renal parapelvic cyst hypertension orthostatic dizziness |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1541880/full |
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