SUN-503 - A Rare Case of A Silent Pheochromocytoma Concomitant with an Incidentally Found Small Bowel Carcinoid Tumor

The co-existence of a pheochromocytoma and a carcinoid tumor is exceedingly rare. We present a case of a silent pheochromocytoma with an incidental finding of a concurrent gastrointestinal carcinoid tumor. A 79-year-old female with no significant medical history presented to her primary care physician for painless hematuria. She underwent a CT scan of the abdomen and pelvis which revealed a large hyper enhancing mass seen in the region of the left adrenal gland with central areas of necrosis and calcification measuring 8.1 X 6.2 cm in size with mass effect on all adjacent structures. Biochemical and urine work up revealed normal androgen, cortisol, aldosterone and renin levels, but illustrated markedly elevated metanephrine and normetanephrine levels suggestive of a pheochromocytoma. Interestingly, the patient denied ever having symptoms of a pheochromocytoma. She was started on doxazosin and a high sodium diet while awaiting surgical consultation. Preoperative CT scan of the abdomen demonstrated again the large heterogenous hyper vascular mass centered in the left adrenal gland with prominent soft tissue components but also showed a partially calcified soft tissue mass within the anterior mesentery which was not previously seen on imaging. She underwent a left mini back scope adrenalectomy and laparoscopic transabdominal adrenalectomy with wide excision of the mesenteric mass and small bowel resection with anastomosis. Final pathology confirmed the left adrenal mass to be a pheochromocytoma, and the small bowel and mesenteric mass revealed a carcinoid tumor. She was referred for genetic testing and continued to remain asymptomatic. The concomitant findings of a pheochromocytoma and carcinoid tumor is exceedingly rare, with only a handful of cases ever reported in literature. This case may underscore that simultaneous pheochromocytoma and carcinoid tumors may be more widespread than previously recognized.

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