Pheochromocytoma in an incidentally discovered asymptomatic cystic adrenalmass

Cystic adrenal lesions can be either cortical or medullary, and distinguish ing between these 2 types of lesions may be important in patient management . Pheochromocytomas, which are adrenal medullary neoplasms, typically manif est with hypertension, headaches, palpitations, tachycardia, sweating, and anxiety symptoms; however, 10% to 17% of patients with pheochromocytomas ar e asymptomatic, We describe a 67-year-old woman with lifelong headaches and recent persistent cough in whom a left cystic adrenal mass was incidentall y discovered by computed tomography of the chest. A moderate increase in no rmetanephrine and total metanephrine values in two 24-hour urine samples su ggested a pheochromocytoma, Computed tomography with use of contrast medium revealed ring enhancement of the cyst wall, a finding consistent with an a drenal medullary tumor, This report demonstrates the importance of repeated 24-hour urine samples to determine the metanephrine values together with c ontrast-enhanced computed tomography in a patient with nonspecific symptoms .