Correspondence

Transient Enhanced Uptake of ¹²³I-Metaiodobenzylguanidine in the Contralateral Adrenal Region after Resection of an Adrenal Pheochromocytoma

N Engl J Med 2000; 342:1450May 11, 2000

Article

To the Editor:

Pheochromocytomas are tumors of chromaffin tissue that may secrete catecholamines continuously or intermittently, thereby causing sustained or paroxysmal hypertension, respectively. After removal of the primary tumor, 6 to 23 percent of patients may have recurrences, and follow-up is therefore essential.1 The tests used for this purpose include measurements of 24-hour urinary catecholamine secretion and the clonidine suppression test. A specific method for detecting chromaffin in tumors is ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy.2 In vitro experiments suggest that MIBG accumulates in adrenergic tissue by means of the norepinephrine-uptake transporter.3 We describe a patient with a pheochromocytoma in whom ¹²³I-MIBG scintigraphy was performed before and after excision of the tumor.

A 53-year-old woman was hospitalized with hypertension, paroxysmal tachycardia, and chest pain. Measurements of catecholamines indicated the presence of a pheochromocytoma. ¹²³I-MIBG scintigraphy revealed intense uptake in the right adrenal region (Figure 1AFigure 1 ¹²³I-MIBG Scintigrams Obtained before and after Resection of a Pheochromocytoma.). Laparoscopic right adrenalectomy was performed, resulting in normalization of catecholamine production. Because of the intense ¹²³I-MIBG uptake in the primary tumor, we performed ¹²³I-MIBG scintigraphy three months after surgery in order to identify other, less active tumor tissue. There was no ¹²³I-MIBG uptake in the right adrenal region, but uptake in the left adrenal region was seen (Figure 1B and Figure 1D). The possibility of an unexpected contralateral tumor was thus raised, but there was no clinical or biochemical evidence of its presence. The patient remained normotensive, and a ¹²³I-MIBG scintigram obtained one year after surgery revealed no accumulation of ¹²³I-MIBG in the left adrenal region (Figure 1C and Figure 1E, facing page).

The transient increase in ¹²³I-MIBG uptake in the left adrenal region after resection of the tumor was probably caused by compensatory hyperplasia of previously less active left adrenal medullary tissue, as reported in rats after unilateral adrenalectomy.4 We conclude that increased ¹²³I-MIBG uptake in the contralateral adrenal gland several months after the removal of a pheochromocytoma need not indicate the presence of another pheochromocytoma.

Hendrikus H. Boersma, Pharm.D.
Johanna W. Wensing, M.D.
T. Liang Kho, M.D., Ph.D.
L. Maurits de Brauw, M.D., Ph.D.
Ing Han Liem, M.D.
Marinus J.P.G. van Kroonenburgh, M.D., Ph.D.
University Hospital Maastricht, NL-6202 AZ Maastricht, the Netherlands

4 References

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