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Case Reports
. 2025 May 26;12(2):93-96.
doi: 10.1016/j.aed.2025.05.004. eCollection 2025 Jul-Aug.

Biochemically Negative Pheochromocytoma With Spontaneous Hemorrhage

Ashley B Vincent  1 , Evelyn J Morales  2 , Leena Shahla  3
Affiliations
Case Reports

Biochemically Negative Pheochromocytoma With Spontaneous Hemorrhage

Ashley B Vincent et al. AACE Endocrinol Diabetes. .

Abstract

Background/objective: Pheochromocytomas are neuroendocrine tumors that arise from adrenomedullary chromaffin cells that produce excess catecholamines. With advancements in imaging modalities, increasing numbers of incidental adrenal masses are discovered with pheochromocytomas making up approximately 4.2% of incidental adrenal masses. The objective of this report is to describe a patient with an unusual presentation of pheochromocytoma that was asymptomatic and lacked classic laboratory findings.

Case report: We present the case of a 31-year-old female who presented to the emergency department with abdominal pain and was found to have an adrenal mass on computed tomography scan. Biopsy of the mass was attempted multiple times prior to biochemical evaluation. The mass was later discovered to be a biochemically negative pheochromocytoma with spontaneous hemorrhage on histological examination following adrenal resection.

Discussion: Pheochromocytomas are the most commonly reported adrenal mass found to have spontaneous hemorrhage. Between 9% and 32% of pheochromocytomas may be biochemically silent adding to the complexity of making an accurate diagnosis and calls into questions current perioperative management of all adrenal masses. In addition, this case serves as a reminder to complete biochemical evaluation prior to invasive adrenal procedures.

Conclusion: This case offers insight into challenges with diagnosis and management of pheochromocytoma with spontaneous hemorrhage, and encourages caution when evaluating adrenal masses due to risk of pheochromocytoma even when biochemically negative.

Keywords: hemorrhage; nonsecretory; pheochromocytoma.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig
Fig
A: Contrast-enhanced venous-phase computed tomography (CT) scan of the abdomen and pelvis sagittal plane. Arrow indicates the right adrenal mass. B: Contrast-enhanced venous-phase computed tomography (CT) scan of the abdomen and pelvis transverse plane. Arrow indicates the right adrenal mass.
See this image and copyright information in PMC

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