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A "Pheo" Lurks: Novel Approaches for Locating Occult Pheochromocytoma

Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development (K.P.); Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke (D.S.G., G.E.); and Department of Radiology, Clinical Center (J.L.D.), National Institutes of Health, Bethesda, Maryland 20892; Division of Nuclear Medicine, Department of Radiology, University of Michigan (B.L.S.), Ann Arbor, Michigan 48109; and Division of Endocrine and Oncologic Surgery, The Johns Hopkins University (R.U.), Baltimore, Maryland 21218

Address all correspondence and requests for reprints to: Karel Pacak, M.D., Ph.D., D.Sc., Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Building 10, Room 9D42, 10 Center Drive, MSC-1583, Bethesda, Maryland 20892-1583. E-mail: karel{at}mail.nih.gov

Abstract

Most, but not all, pheochromocytomas can be localized by computed tomography or magnetic resonance imaging. Here we introduce two novel approaches for localization of pheochromocytoma in a patient in whom conventional imaging modalities failed to show the tumor. First, we establish that measurements of plasma free metanephrines coupled with vena caval sampling are useful for localizing occult pheochromocytoma, particularly when elevations in plasma catecholamines are slight or intermittent. Second, we show that positron emission tomographic scanning using the imaging agent 6-[¹⁸F]fluorodopamine as a substrate for the norepinephrine transporter offers a highly effective method for tumor localization. These novel approaches may be of value in difficult cases, where biochemical and clinical evidence of pheochromocytoma is compelling, yet conventional imaging modalities fail to locate the tumor.

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