Benign Pheochromocytoma Coming Back with Bony Metastasis: A Case Report and Literature Review

Abstract

Pheochromocytoma is an uncommon adrenal medulla tumor that secretes catecholamines. It is usually a benign condition and is generally treated with adrenalectomy; in a small proportion of cases, however, it might return or spread. Pheochromocytoma is uncommon to recur or metastasize, meaning every reported case is clinically relevant. 

A 46-year-old Caucasian woman initially presented with conventional catecholamine excess symptoms—refractory hypertension, palpitations, diaphoresis, and headaches. Imaging showed a sizable right adrenal mass; biochemical testing indicated very high plasma metanephrines. A medical decision was made to perform a right adrenalectomy; pathology confirmed a benign pheochromocytoma. After surgery, her symptoms went away, but she was missed for follow-up. Four years later, she came back with comparable symptoms; biochemical screening found increased metanephrines once more, and a computed tomography (CT) scan revealed local recurrence in the right adrenal bed. Notably, the CT also disclosed a lytic lesion in a lumbar vertebra and evidence of bone metastases from the pheochromocytoma. This instance highlights a rare situation in which a pheochromocytoma, initially thought to be innocuous, reoccurred with distant skeletal involvement.

In conclusion, a very rare, recurrent pheochromocytoma with bone metastases underscores the importance of continuous monitoring even after complete tumor removal. Early recognition of metastasis or relapse can significantly impact therapy and outcomes. This case highlights the necessity of ongoing follow-up in patients with pheochromocytoma and alerts individuals to potential late metastatic symptoms.