Clinically Silent Pheochromocytoma in Adrenal Incidentaloma: A Case Report

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 g/day) and metanephrine (3988.77g/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.