The cortex originates around the fifth week of gestation from mesodermal tissue near the gonads on the adrenogenital ridge
Ectopic adrenocortical tissue may be found in the ovaries, spermatic cord, and testes.
Q A 50-year-old patient with a history of pheochromocytoma presents with symptoms of bone pain, persistent hypertension, and fatigue. Imaging reveals metastases in the axial skeleton and liver. Biopsy confirms the diagnosis of metastatic pheochromocytoma.
What is the recommended approach to manage this patient’s condition
A. Initiate chemotherapy and radiotherapy as first-line treatment for metastatic control. B. Proceed with surgical resection of metastases to alleviate symptoms and reduce catecholamine levels. C. Begin chronic management of catecholamine excess using beta-blockers alone. D. Avoid surgical intervention due to the minimal survival benefit in metastatic pheochromocytoma.
B. Proceed with surgical resection of metastases to alleviate symptoms and reduce catecholamine levels.
Explanation of Answer Choices:
A. Initiate chemotherapy and radiotherapy as first-line treatment for metastatic control. Why it’s incorrect: Malignant pheochromocytomas generally respond poorly to chemotherapy and radiotherapy, so these are not first-line treatments. Surgical resection is the preferred option for palliative benefits and symptom control.
B. Proceed with surgical resection of metastases to alleviate symptoms and reduce catecholamine levels. Why it’s correct: Surgical resection is recommended for palliative management in metastatic pheochromocytoma. Even if it does not offer a cure, it can significantly improve symptoms and reduce the systemic effects of catecholamine excess.
C. Begin chronic management of catecholamine excess using beta-blockers alone. Why it’s incorrect: Beta-blockers should not be used alone without alpha-blockers in pheochromocytoma due to the risk of unopposed alpha stimulation, which could worsen blood pressure control. Alpha-blockers are preferred as initial management.
D. Avoid surgical intervention due to the minimal survival benefit in metastatic pheochromocytoma. Why it’s incorrect: Surgical resection can provide meaningful palliative benefits, including symptom relief and management of catecholamine excess, even if it does not improve survival significantly.
