The Diagnostic Ambiguities of Pheochromocytoma—Insights from Radiological Pitfalls: A Case Report

Aims and background: Adrenocortical carcinoma and pheochromocytoma are distinct adrenal malignancies with different clinical presentations and origins. Adrenocortical tumors often manifest through hormone overproduction, whereas pheochromocytomas secrete catecholamines, necessitating meticulous diagnostic evaluation due to their varied clinical and radiographic features. This report aims to elucidate the diagnostic approach, surgical management, and clinical outcomes in a case of pheochromocytoma. Case description: A 36-year-old woman presented with sporadic episodes of palpitations, sweating, flushing, and abdominal discomfort. Elevated plasma metanephrines were detected during laboratory investigations. Imaging revealed a well-defined, round lesion in the right suprarenal region, exhibiting solid-cystic features and vascularity. Surgical exploration uncovered a tumor in the right adrenal gland. Histopathological analysis confirmed the diagnosis of pheochromocytoma. Postoperative management led to significant symptomatic relief and a marked reduction in plasma metanephrine levels. Conclusion: Pheochromocytoma should be considered in patients exhibiting episodic symptoms such as palpitations, sweating, and flushing, particularly when associated with elevated plasma metanephrines. Imaging is vital for tumor localization, and surgical resection is the definitive treatment. Clinical significance: This case highlights the critical importance of comprehensive diagnostic evaluation for adrenal masses and underscores the clinical presentation of pheochromocytoma. Early diagnosis and surgical intervention can result in symptomatic improvement and normalization of catecholamine levels, thereby enhancing patient outcomes.