Fig. 6

Clinical cases presenting large size pheochromocytomas in three patients suspicious for PPGL. Patient 1 (image A, B, C). 51-year-old women with a history of hypertension and paroxysmal palpitations, sweating and headache. Preoperative plasma normetanephrines were 13.30 and 12.30 (< 0.98 nmol/L) and metanephrines 1.07 and 0.99 (< 0.45 nmol/L). Pathology confirmed a 66-mm pheochromocytoma with a PASS score of 10. Symptoms, blood pressure and plasma metanephrines were normalized after surgical resection. Patient 2 (image D, E, F). 72-year-old male with a history of hypertension, weight loss, discomfort, and paroxysmal palpitations. Preoperative plasma normetanephrines were 6.36 and 7.68 (< 1.07 nmol/L) and metanephrines 6.55 and 7.46 (< 0.45 nmol/L). Pathology confirmed a 38-mm pheochromocytoma with a PASS score of 7. Symptoms, blood pressure and plasma metanephrines were normalized after surgical resection. Patient 3 (image G, H, I). 69-year-old male with a 10-year history of hypertension. Within the last year paroxysmal palpitations, nausea, and sweating. Preoperative plasma normetanephrines were 4.70 and 4.98 (< 1.07 nmol/L) and metanephrines 14.80 and 12.90 (< 0.45 nmol/L). Pathology confirmed a 45-mm pheochromocytoma with a PASS score of 9. Symptoms, blood pressure, and plasma metanephrines were normalized after surgical resection. The images show transaxial slides of the adrenal glands on a contrast-enhanced CT (left column, image A, D and G), FDOPA PET/CT (middle column, image B, E, and H) and DOTATOC PET/CT (right column, panel C, F, and I). Images B, E, and H show high FDOPA uptake within (B, E) or in the periphery (H) of nodular structures measuring 45, 58, and 66 mm, respectively. Images C, F, and I show uptake of DOTATOC below the physiological uptake of the adjacent and contralateral adrenal gland in each of the three patients. Patient 3 had a tumor in the right adrenal gland with central bleeding and a contrast-enhanced peripheral zone with high FDOPA uptake and no DOTATOC uptake besides physiological uptake medial to the tumor (image G, H, I)