Feocromocitoma: punción y drenaje percutáneo precirugía en un caso que se presentó como absceso retroperitoneal / Percutaneous puncture and drainage previous to elective surgical resection of a pheochromocytoma presenting as a retroperitoneal abscess: Report of one case

We report a 57 year-old woman with a big partially cystic adrenal pheochromocytoma presenting with high fever and abdominal pain. Based on CT scan images and before knowing urinary catecholamines level, the diagnosis of sepsis secondary to an abscessed adrenal macrotumor was done. A diagnostic percutaneous fine-needle puncture and aspiration was done and antibiotic therapy was started. One week later an open surgical drainage and installation of percutaneous drainage tubes was carried out. Both procedures were uneventful and the patient improved dramatically. Three months later a definitive excision surgery was done. After 14 months of follow up, the patient is in excellent conditions and her abdominal CT scan is normal.

Incidentaloma adrenal com elevaçäo de normetanefrinas urinárias: Caso 04/96 (MAM, RG 095.567-2, Santa Casa de Misericórdia de Belo Horizonte, MG) / Incidental adrenal masses with increase of urinary normetanephrine: Case 04/96 (MAM, RG 095.567-2, Santa Casa de Misericórdia de Belo Horizonte, MG)

O avanço tecnológico na obtençäo de imagens em medicina (ultrassonografia, tomografia computadorizada e ressonância nuclear magnética) tem proporcionado uma precisäo de detalhes cada vez maior. Por isso, a incidência de achados de massas acidentais está aumentando na mesma proporçäo, obrigando-nos a deparar com novos desafios diagnósticos e terapêuticos. O incidentaloma da adrenal apresenta-se nesta categoria, constituindo um problema diagnóstico e um dilema terapêutico. O feocromocitoma é um tumor raro, que incide em apenas 0,1 por cento dos indivíduos hipertensos e se carateriza por extrema variabilidade na sua expressäo clínica. Raramente o tumor é clinicamente silencioso, porém, frequentemente, seu diagnóstico é estabelecido somente após remoçäo de um incidentaloma adrenal ou autópsia. Neste relato de caso apresentamos uma paciente assintomática, portadora de feocromocitoma silencioso, com aumento apenas dos níveis de normetanefrinas urinárias, alertando para a importância da investigaçäo funcional destas massas encontradas incidentalmente. Os resultados alterados em apenas um dos metabólitos urinários de catecolaminas (HPLC) confirmam achados prévios, de serem estes os mais sensíveis para investigaçäo dos incidentalomas adrenais na detecçäo de feocromocitomas.

Comparative study of vanillylmandelic acid in random and 24-hour urine collections.

Urinary vanillylmandelic acid (VMA) levels were determined in random samples and in 24-hour collections from 52 patients. Random sample levels were compared with levels in 24-hour collections and showed good correlation (r = 0.99), and no statistically significant differences was found when urinary VMA levels in random samples expressed in micrograms/mg creatinine (p greater than 0.1). Normal values of VMA in random urine samples of 226 healthy volunteers for different age groups of 1-5, 6-10, 11-15, 16-30, 31-60 years old were 17.03 +/- 6.61, 10.32 +/- 3.25, 10.87 +/- 4.5, 7.62 +/- 3.05 and 7.79 +/- 3.94 micrograms/mg of creatinine respectively.