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Case Reports
. 2025 Jun 12;17(6):e85885.
doi: 10.7759/cureus.85885. eCollection 2025 Jun.

A Rare Case of Bilateral Pheochromocytomas: Diagnostic and Surgical Challenges in a 38-Year-Old Female

Jawad Khan  1 , Malik Furqan Mahmood  1 , Mudassar Abbas  2 , Aleena Ejaz  3 , Eman Riaz  4
Affiliations
Case Reports

A Rare Case of Bilateral Pheochromocytomas: Diagnostic and Surgical Challenges in a 38-Year-Old Female

Jawad Khan et al. Cureus. .

Abstract

Pheochromocytomas are rare tumors of the adrenal medulla, and bilateral involvement is especially uncommon in the absence of a hereditary syndrome. We present the case of a 38-year-old female who presented with bilateral flank pain, excessive sweating, and palpitations. Clinical examination and laboratory investigations revealed elevated blood pressure and markedly increased serum metanephrines and normetanephrines. Imaging identified large bilateral adrenal masses with features suggestive of pheochromocytomas. A multidisciplinary team opted for a staged surgical approach: a left adrenalectomy followed by a right cortical-sparing adrenalectomy. The patient was adequately prepared preoperatively with alpha- and beta-blockers to reduce the risk of intraoperative hypertensive crisis. Histopathology confirmed pheochromocytoma in both adrenal glands. Postoperative management included steroid replacement therapy and regular monitoring of adrenal hormone levels to assess the functionality of the remaining adrenal tissue. Genetic testing was offered to assess for underlying genetic causes, but was declined by the patient. This case illustrates the importance of individualized, multidisciplinary care in managing bilateral pheochromocytomas, with emphasis on preserving adrenal function and ensuring long-term surveillance.

Keywords: adrenal surgery; adrenal tumors; bilateral pheochromocytoma; catecholamine-secreting tumor; cortical-sparing adrenalectomy; hypertension; multidisciplinary approach; staged adrenalectomy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Gross specimen of the resected right adrenal pheochromocytoma
The tumor appears encapsulated with a smooth external surface, areas of hemorrhage, and yellowish discoloration; consistent with its vascular and lipid-rich nature.
Figure 2
Figure 2. Gross specimen of the resected left adrenal pheochromocytoma
The mass appears well-circumscribed and encapsulated, with heterogeneous areas of hemorrhage and congestion on the external surface, consistent with the tumor's vascular nature.
Figure 3
Figure 3. Axial contrast-enhanced CT Scan
The scan shows bilateral adrenal masses consistent with pheochromocytomas. The right adrenal mass (green arrow) appears well-defined and heterogeneously enhancing, while the left adrenal mass (red arrow) shows similar enhancement characteristics. No evidence of local invasion or distant metastasis is seen.
Figure 4
Figure 4. Histopathology image showing pheochromocytoma
The H&E magnification (20x) shows a nested pattern of large polyclonal cells with abundant cytoplasm and uniform nuclei (black arrow). H&E: Hematoxylin and eosin
Figure 5
Figure 5. Immunohistochemical staining showing diffuse cytoplasmic positivity
The IHC stain synaptophysin is diffusely positive in neoplastic cells (H&E magnification, 20x). IHC: Immunohistochemical, H&E: Hematoxylin and eosin
See this image and copyright information in PMC

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