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Pheochromocytoma
Mitchell Tublin, MD; Mark D. Sugi, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Tumor arising from chromaffin cells of adrenal medulla or sympathetic nervous system
              • Extraadrenal pheochromocytoma: Paraganglioma, ganglioneuroma

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Reporting Tips

                                            Selected References

                                            1. Jain A et al: Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management. Pediatr Nephrol. 35(4):581-94, 2020
                                            2. Kang S et al: Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdom Radiol (NY). 46(3):1082-90, 2020
                                            3. Alshahrani MA et al: Bilateral adrenal abnormalities: imaging review of different entities. Abdom Radiol (NY). 44(1):154-79, 2019
                                            4. Canu L et al: CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma. J Clin Endocrinol Metab. 104(2):312-8, 2019
                                            5. Gong X et al: Ultrasonographic findings of 1385 adrenal masses: a retrospective study of 1319 benign and 66 malignant masses. J Ultrasound Med. 38(9):2249-57, 2019
                                            6. Goroshi M et al: Radiological differentiation of phaeochromocytoma from other malignant adrenal masses: importance of wash-in characteristics on multiphase CECT. Endocr Connect. 8(7):898-905, 2019
                                            7. Neumann HPH et al: Comparison of pheochromocytoma-specific morbidity and mortality among adults with bilateral pheochromocytomas undergoing total adrenalectomy vs cortical-sparing adrenalectomy. JAMA Netw Open. 2(8):e198898, 2019
                                            8. Pryma DA et al: Efficacy and safety of high-specific-activity 131I-MIBG therapy in patients with advanced pheochromocytoma or paraganglioma. J Nucl Med. 60(5):623-30, 2019
                                            9. Foti G et al: Characterization of adrenal lesions using MDCT wash-out parameters: diagnostic accuracy of several combinations of intermediate and delayed phases. Radiol Med. 123(11):833-40, 2018
                                            10. Mohammed MF et al: Pheochromocytomas versus adenoma: role of venous phase CT enhancement. AJR Am J Roentgenol. 210(5):1073-8, 2018
                                            11. Woo S et al: Pheochromocytoma as a frequent false-positive in adrenal washout CT: a systematic review and meta-analysis. Eur Radiol. 28(3):1027-36, 2018
                                            12. Kim DW et al: Assessment of clinical and radiologic differences between small and large adrenal pheochromocytomas. Clin Imaging. 43:153-7, 2017
                                            13. Mendiratta-Lala M et al: Adrenal imaging. Endocrinol Metab Clin North Am. 46(3):741-59, 2017
                                            14. Schieda N et al: Update on CT and MRI of adrenal nodules. AJR Am J Roentgenol. 1-12, 2017
                                            15. Zhang GM et al: Differentiating pheochromocytoma from lipid-poor adrenocortical adenoma by CT texture analysis: feasibility study. Abdom Radiol (NY). 42(9):2305-13, 2017
                                            16. Northcutt BG et al: Adrenal adenoma and pheochromocytoma: comparison of multidetector CT venous enhancement levels and washout characteristics. J Comput Assist Tomogr. 40(2):194-200, 2016
                                            17. Schieda N et al: Comparison of quantitative MRI and CT washout analysis for differentiation of adrenal pheochromocytoma from adrenal adenoma. AJR Am J Roentgenol. 206(6):1141-8, 2016
                                            18. Borhani AA et al: Quantitative versus qualitative methods in evaluation of T2 signal intensity to improve accuracy in diagnosis of pheochromocytoma. AJR Am J Roentgenol. 205(2):302-10, 2015
                                            19. Derlin T et al: Intraindividual comparison of 123I-mIBG SPECT/MRI, 123I-mIBG SPECT/CT, and MRI for the detection of adrenal pheochromocytoma in patients with elevated urine or plasma catecholamines. Clin Nucl Med. 38(1):e1-6, 2013
                                            20. Leung K et al: Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging. AJR Am J Roentgenol. 200(2):370-8, 2013
                                            21. Northcutt BG et al: MDCT of adrenal masses: can dual-phase enhancement patterns be used to differentiate adenoma and pheochromocytoma? AJR Am J Roentgenol. 201(4):834-9, 2013
                                            22. Patel J et al: Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma? AJR Am J Roentgenol. 201(1):122-7, 2013
                                            23. Raja A et al: Multimodality imaging findings of pheochromocytoma with associated clinical and biochemical features in 53 patients with histologically confirmed tumors. AJR Am J Roentgenol. 201(4):825-33, 2013
                                            24. Dong Y et al: Differentiation of malignant from benign pheochromocytomas with diffusion-weighted and dynamic contrast-enhanced magnetic resonance at 3.0 T. J Comput Assist Tomogr. 36(4):361-6, 2012
                                            25. Timmers HJ et al: Current and future anatomical and functional imaging approaches to pheochromocytoma and paraganglioma. Horm Metab Res. 44(5):367-72, 2012
                                            26. Miller FH et al: Utility of diffusion-weighted MRI in characterization of adrenal lesions. AJR Am J Roentgenol. 194(2):W179-85, 2010
                                            27. Blake MA et al: Pheochromocytoma: an imaging chameleon. Radiographics. 24 Suppl 1:S87-99, 2004
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Tumor arising from chromaffin cells of adrenal medulla or sympathetic nervous system
                                                        • Extraadrenal pheochromocytoma: Paraganglioma, ganglioneuroma

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Angiographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Jain A et al: Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management. Pediatr Nephrol. 35(4):581-94, 2020
                                                                                      2. Kang S et al: Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdom Radiol (NY). 46(3):1082-90, 2020
                                                                                      3. Alshahrani MA et al: Bilateral adrenal abnormalities: imaging review of different entities. Abdom Radiol (NY). 44(1):154-79, 2019
                                                                                      4. Canu L et al: CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma. J Clin Endocrinol Metab. 104(2):312-8, 2019
                                                                                      5. Gong X et al: Ultrasonographic findings of 1385 adrenal masses: a retrospective study of 1319 benign and 66 malignant masses. J Ultrasound Med. 38(9):2249-57, 2019
                                                                                      6. Goroshi M et al: Radiological differentiation of phaeochromocytoma from other malignant adrenal masses: importance of wash-in characteristics on multiphase CECT. Endocr Connect. 8(7):898-905, 2019
                                                                                      7. Neumann HPH et al: Comparison of pheochromocytoma-specific morbidity and mortality among adults with bilateral pheochromocytomas undergoing total adrenalectomy vs cortical-sparing adrenalectomy. JAMA Netw Open. 2(8):e198898, 2019
                                                                                      8. Pryma DA et al: Efficacy and safety of high-specific-activity 131I-MIBG therapy in patients with advanced pheochromocytoma or paraganglioma. J Nucl Med. 60(5):623-30, 2019
                                                                                      9. Foti G et al: Characterization of adrenal lesions using MDCT wash-out parameters: diagnostic accuracy of several combinations of intermediate and delayed phases. Radiol Med. 123(11):833-40, 2018
                                                                                      10. Mohammed MF et al: Pheochromocytomas versus adenoma: role of venous phase CT enhancement. AJR Am J Roentgenol. 210(5):1073-8, 2018
                                                                                      11. Woo S et al: Pheochromocytoma as a frequent false-positive in adrenal washout CT: a systematic review and meta-analysis. Eur Radiol. 28(3):1027-36, 2018
                                                                                      12. Kim DW et al: Assessment of clinical and radiologic differences between small and large adrenal pheochromocytomas. Clin Imaging. 43:153-7, 2017
                                                                                      13. Mendiratta-Lala M et al: Adrenal imaging. Endocrinol Metab Clin North Am. 46(3):741-59, 2017
                                                                                      14. Schieda N et al: Update on CT and MRI of adrenal nodules. AJR Am J Roentgenol. 1-12, 2017
                                                                                      15. Zhang GM et al: Differentiating pheochromocytoma from lipid-poor adrenocortical adenoma by CT texture analysis: feasibility study. Abdom Radiol (NY). 42(9):2305-13, 2017
                                                                                      16. Northcutt BG et al: Adrenal adenoma and pheochromocytoma: comparison of multidetector CT venous enhancement levels and washout characteristics. J Comput Assist Tomogr. 40(2):194-200, 2016
                                                                                      17. Schieda N et al: Comparison of quantitative MRI and CT washout analysis for differentiation of adrenal pheochromocytoma from adrenal adenoma. AJR Am J Roentgenol. 206(6):1141-8, 2016
                                                                                      18. Borhani AA et al: Quantitative versus qualitative methods in evaluation of T2 signal intensity to improve accuracy in diagnosis of pheochromocytoma. AJR Am J Roentgenol. 205(2):302-10, 2015
                                                                                      19. Derlin T et al: Intraindividual comparison of 123I-mIBG SPECT/MRI, 123I-mIBG SPECT/CT, and MRI for the detection of adrenal pheochromocytoma in patients with elevated urine or plasma catecholamines. Clin Nucl Med. 38(1):e1-6, 2013
                                                                                      20. Leung K et al: Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging. AJR Am J Roentgenol. 200(2):370-8, 2013
                                                                                      21. Northcutt BG et al: MDCT of adrenal masses: can dual-phase enhancement patterns be used to differentiate adenoma and pheochromocytoma? AJR Am J Roentgenol. 201(4):834-9, 2013
                                                                                      22. Patel J et al: Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma? AJR Am J Roentgenol. 201(1):122-7, 2013
                                                                                      23. Raja A et al: Multimodality imaging findings of pheochromocytoma with associated clinical and biochemical features in 53 patients with histologically confirmed tumors. AJR Am J Roentgenol. 201(4):825-33, 2013
                                                                                      24. Dong Y et al: Differentiation of malignant from benign pheochromocytomas with diffusion-weighted and dynamic contrast-enhanced magnetic resonance at 3.0 T. J Comput Assist Tomogr. 36(4):361-6, 2012
                                                                                      25. Timmers HJ et al: Current and future anatomical and functional imaging approaches to pheochromocytoma and paraganglioma. Horm Metab Res. 44(5):367-72, 2012
                                                                                      26. Miller FH et al: Utility of diffusion-weighted MRI in characterization of adrenal lesions. AJR Am J Roentgenol. 194(2):W179-85, 2010
                                                                                      27. Blake MA et al: Pheochromocytoma: an imaging chameleon. Radiographics. 24 Suppl 1:S87-99, 2004