ArticleFrontiers in oncology2026
Case Report: The silent giant: biochemical-clinical dissociation in a large cystic pheochromocytoma.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Asymptomatic pheochromocytomas are increasingly detected as incidentalomas. However, large tumors presenting with marked biochemical elevation but complete clinical silence ("biochemical-clinical dissociation") are rare and prone to catastrophic mismanagement if mistaken for non-functional masses. Case presentation: We report a case of a 43-year-old normotensive female presenting with a large (57×53 mm) incidental left adrenal mass. Abdominal imaging revealed a cystic-solid tumor with intratumoral hemorrhage. Despite the complete absence of sympathetic symptoms, biochemical evaluation showed markedly elevated plasma normetanephrine levels (1168.0 pg/ml), indicating significant secretory activity. The patient was successfully managed with preoperative alpha-blockade (doxazosin) and volume expansion, followed by an uneventful transperitoneal laparoscopic adrenalectomy. Histopathology confirmed a pheochromocytoma with loss of SDHB expression. Conclusion: This suggests a multifactorial mechanism involving cystic sequestration and biochemical alterations associated with SDHB deficiency. Clinicians must recognize that biochemistry, not symptoms, dictates management. Mandatory preoperative α-blockade remains the cornerstone for preventing lethal intraoperative hemodynamic crises in these "silent" yet biochemically active tumors.
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