{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:58:57Z","timestamp":1769727537993,"version":"3.49.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,11,18]]},"abstract":"\n BACKGROUND<\/jats:title>\n Undiagnosed pheochromocytoma can present with hemodynamic instability during surgical procedures. Here, the authors discuss a 69-year-old male with isocitrate dehydrogenase (IDH)\u2013wildtype glioblastoma copresenting with undiagnosed pheochromocytoma, which, to the authors\u2019 knowledge, is the second reported case in the literature.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The patient presented to the emergency department with a 1-month history of coordination difficulties, progressive morning headache, and mild left-side weakness. Imaging showed a 5-cm peripherally enhancing intra-axial right parietal mass with surrounding vasogenic edema. Intraoperatively, the patient had significant uncontrollable hypertension up to 240\/120 mm Hg, and the operation was promptly aborted. Contrast-enhanced computed tomography imaging of the chest, abdomen, and pelvis identified a 4.9-cm left adrenal mass of indeterminant etiology. Endocrinology diagnosed the incidentaloma as a pheochromocytoma, initiating alpha blockade followed by beta blockade, and the urology service performed a laparoscopic adrenalectomy after patient stabilization. The neurosurgery service removed the intra-axial brain lesion 2 days after adrenalectomy, which was diagnosed as IDH-wildtype glioblastoma. The patient was discharged home after 6 days in stable condition.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights the importance of preoperative screening for pheochromocytoma in neurosurgical patients with adrenal incidentalomas, especially in incidentalomas > 4 cm, even without high clinical suspicion.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24374<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24374","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T01:44:56Z","timestamp":1731894296000},"source":"Crossref","is-referenced-by-count":0,"title":["Perioperative management of patients with glioblastoma copresenting with pheochromocytoma: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Eddie","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Keough","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda M.","family":"Henderson","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan M.","family":"Hagen","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada"},{"name":"Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max A.","family":"Levine","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terra","family":"Arnason","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada"},{"name":"Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolyn","family":"Au","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"N Engl J Med","first-page":"552","article-title":"Pheochromocytoma and paraganglioma","volume":"381","author":"Neumann","year":"2019","unstructured":"Neumann HPHYoung WFJrEng C. Pheochromocytoma and paraganglioma. N Engl J Med. 2019;381(6):552-565."},{"issue":"1","key":"bib2","series-title":"Endocr Connect","first-page":"186","article-title":"Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center","volume":"7","author":"Falhammar","year":"2018","unstructured":"Falhammar HKjellman MCalissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018;7(1):186-192."},{"issue":"1","key":"bib3","series-title":"Urology","first-page":"1","article-title":"Pheochromocytoma: clinical manifestations and diagnostic tests","volume":"17","author":"Juan","year":"1981","unstructured":"Juan D. Pheochromocytoma: clinical manifestations and diagnostic tests. Urology. 1981;17(1):1-12."},{"issue":"11","key":"bib4","series-title":"J Clin Pathol","first-page":"1168","article-title":"Adrenal incidentaloma: evaluation and management","volume":"61","author":"Singh","year":"2008","unstructured":"Singh PKBuch HN. Adrenal incidentaloma: evaluation and management. J Clin Pathol. 2008;61(11):1168-1173."},{"issue":"4","key":"bib5","series-title":"J Endocrinol Invest","first-page":"298","article-title":"Prevalence of adrenal incidentaloma in a contemporary computerized tomography series","volume":"29","author":"Bovio","year":"2006","unstructured":"Bovio SCataldi AReimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006;29(4):298-302."},{"issue":"2","key":"bib6","series-title":"Can Urol Assoc J","first-page":"12","article-title":"Canadian Urological Association guideline: diagnosis, management, and followup of the incidentally discovered adrenal mass","volume":"17","author":"Rowe","year":"2023","unstructured":"Rowe NEKumar RMSchieda N, et al. Canadian Urological Association guideline: diagnosis, management, and followup of the incidentally discovered adrenal mass. Can Urol Assoc J. 2023;17(2):12-24."},{"issue":"2","key":"bib7","series-title":"J Clin Endocrinol Metab","first-page":"637","article-title":"A survey on adrenal incidentaloma in Italy","volume":"85","author":"Mantero","year":"2000","unstructured":"Mantero FTerzolo MArnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000;85(2):637-644."},{"issue":"2","key":"bib8","series-title":"J Clin Endocrinol Metab","first-page":"312","article-title":"CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma","volume":"104","author":"Canu","year":"2019","unstructured":"Canu LVan Hemert JAWKerstens MN, et al. CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma. J Clin Endocrinol Metab. 2019;104(2):312-318."},{"issue":"1","key":"bib9","series-title":"Eur J Endocrinol","first-page":"G1","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"189","author":"Fassnacht","year":"2023","unstructured":"Fassnacht MTsagarakis STerzolo M, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023;189(1):G1-G42."},{"issue":"1","key":"bib10","series-title":"Sci Rep","first-page":"2671","article-title":"Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours","volume":"12","author":"Araujo-Castro","year":"2022","unstructured":"Araujo-Castro MGarc\u00eda Centeno RRobles L\u00e1zaro C, et al. Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours. Sci Rep. 2022;12(1):2671."},{"issue":"6","key":"bib11","series-title":"J Am Coll Surg","first-page":"727","article-title":"Clinical spectrum of pheochromocytoma","volume":"209","author":"Guerrero","year":"2009","unstructured":"Guerrero MASchreinemakers JMJVriens MR, et al. Clinical spectrum of pheochromocytoma. 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Curr Hypertens Rep. 2008;10(1):12-18."},{"issue":"2","key":"bib14","series-title":"Endocrinol Metab Clin North Am","first-page":"279","article-title":"Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness","volume":"40","author":"Schwartz","year":"2011","unstructured":"Schwartz GL. Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness. Endocrinol Metab Clin North Am. 2011;40(2):279-294."},{"key":"bib15","series-title":"J Diabetes Metab Disord","first-page":"42","article-title":"Correction to: does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms","volume":"16","author":"Soltani","year":"2017","unstructured":"Soltani APourian MDavani BM. Correction to: does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2017;16:42."},{"issue":"5","key":"bib16","series-title":"Ann Surg Oncol","first-page":"1444","article-title":"Inherited mutations in pheochromocytoma and paraganglioma: why all patients should be offered genetic testing","volume":"20","author":"Fishbein","year":"2013","unstructured":"Fishbein LMerrill SFraker DLCohen DLNathanson KL. Inherited mutations in pheochromocytoma and paraganglioma: why all patients should be offered genetic testing. Ann Surg Oncol. 2013;20(5):1444-1450."},{"issue":"3","key":"bib17","series-title":"AJR Am J Roentgenol","first-page":"636","article-title":"Diagnostic value of CT of chest, abdomen, and pelvis in patients with solitary and multiple brain lesions","volume":"214","author":"Rothman","year":"2020","unstructured":"Rothman RKWeinreb JZucconi WMalhotra A. Diagnostic value of CT of chest, abdomen, and pelvis in patients with solitary and multiple brain lesions. AJR Am J Roentgenol. 2020;214(3):636-640."},{"issue":"4","key":"bib18","series-title":"Acta Neurochir (Wien)","first-page":"1065","article-title":"When is a staging scan required for newly diagnosed brain lesions on CT? A multivariate logistic regression analysis","volume":"165","author":"Ali","year":"2023","unstructured":"Ali AMSVarasteh AAKonteas AB, et al. When is a staging scan required for newly diagnosed brain lesions on CT? A multivariate logistic regression analysis. Acta Neurochir (Wien). 2023;165(4):1065-1073."},{"issue":"1","key":"bib19","series-title":"Br J Neurosurg","first-page":"89","article-title":"Case report of a suspected pheochromocytoma co-presenting with a glioblastoma multiforme: case report and review of the literature","volume":"34","author":"Tresman","year":"2020","unstructured":"Tresman RDubois CLethbridge E, et al. Case report of a suspected pheochromocytoma co-presenting with a glioblastoma multiforme: case report and review of the literature. Br J Neurosurg. 2020;34(1):89-90."},{"issue":"3","key":"bib20","series-title":"Pharmacol Rev","first-page":"331","article-title":"Catecholamine metabolism: a contemporary view with implications for physiology and medicine","volume":"56","author":"Eisenhofer","year":"2004","unstructured":"Eisenhofer GKopin IJGoldstein DS. Catecholamine metabolism: a contemporary view with implications for physiology and medicine. Pharmacol Rev. 2004;56(3):331-349."},{"issue":"2","key":"bib21","series-title":"Endocrinol Metab Clin North Am","first-page":"295","article-title":"Hypertension in pheochromocytoma: characteristics and treatment","volume":"40","author":"Zuber","year":"2011","unstructured":"Zuber SMKantorovich VPacak K. Hypertension in pheochromocytoma: characteristics and treatment. Endocrinol Metab Clin North Am. 2011;40(2):295-311."},{"issue":"11","key":"bib22","series-title":"J Clin Endocrinol Metab","first-page":"4069","article-title":"Preoperative management of the pheochromocytoma patient","volume":"92","author":"Pacak","year":"2007","unstructured":"Pacak K. Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab. 2007;92(11):4069-4079."},{"issue":"5","key":"bib23","series-title":"Eur J Endocrinol","first-page":"951","article-title":"Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma","volume":"162","author":"Grouzmann","year":"2010","unstructured":"Grouzmann EDrouard-Troalen LBaudin E, et al. Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma. Eur J Endocrinol. 2010;162(5):951-960."},{"issue":"3","key":"bib24","series-title":"Endocr J","first-page":"243","article-title":"Diagnostic accuracy of plasma free metanephrines in a seated position compared with 24-hour urinary metanephrines in the investigation of pheochromocytoma","volume":"62","author":"Kim","year":"2015","unstructured":"Kim HJLee JICho YY, et al. Diagnostic accuracy of plasma free metanephrines in a seated position compared with 24-hour urinary metanephrines in the investigation of pheochromocytoma. Endocr J. 2015;62(3):243-250."},{"issue":"6","key":"bib1","series-title":"N Engl J Med","first-page":"552","article-title":"Pheochromocytoma and paraganglioma","volume":"381","author":"Neumann","year":"2019","unstructured":"Neumann HPHYoung WFJrEng C. Pheochromocytoma and paraganglioma. N Engl J Med. 2019;381(6):552-565."},{"issue":"1","key":"bib2","series-title":"Endocr Connect","first-page":"186","article-title":"Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center","volume":"7","author":"Falhammar","year":"2018","unstructured":"Falhammar HKjellman MCalissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018;7(1):186-192."},{"issue":"1","key":"bib3","series-title":"Urology","first-page":"1","article-title":"Pheochromocytoma: clinical manifestations and diagnostic tests","volume":"17","author":"Juan","year":"1981","unstructured":"Juan D. Pheochromocytoma: clinical manifestations and diagnostic tests. Urology. 1981;17(1):1-12."},{"issue":"11","key":"bib4","series-title":"J Clin Pathol","first-page":"1168","article-title":"Adrenal incidentaloma: evaluation and management","volume":"61","author":"Singh","year":"2008","unstructured":"Singh PKBuch HN. Adrenal incidentaloma: evaluation and management. J Clin Pathol. 2008;61(11):1168-1173."},{"issue":"4","key":"bib5","series-title":"J Endocrinol Invest","first-page":"298","article-title":"Prevalence of adrenal incidentaloma in a contemporary computerized tomography series","volume":"29","author":"Bovio","year":"2006","unstructured":"Bovio SCataldi AReimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006;29(4):298-302."},{"issue":"2","key":"bib6","series-title":"Can Urol Assoc J","first-page":"12","article-title":"Canadian Urological Association guideline: diagnosis, management, and followup of the incidentally discovered adrenal mass","volume":"17","author":"Rowe","year":"2023","unstructured":"Rowe NEKumar RMSchieda N, et al. Canadian Urological Association guideline: diagnosis, management, and followup of the incidentally discovered adrenal mass. Can Urol Assoc J. 2023;17(2):12-24."},{"issue":"2","key":"bib7","series-title":"J Clin Endocrinol Metab","first-page":"637","article-title":"A survey on adrenal incidentaloma in Italy","volume":"85","author":"Mantero","year":"2000","unstructured":"Mantero FTerzolo MArnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000;85(2):637-644."},{"issue":"2","key":"bib8","series-title":"J Clin Endocrinol Metab","first-page":"312","article-title":"CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma","volume":"104","author":"Canu","year":"2019","unstructured":"Canu LVan Hemert JAWKerstens MN, et al. CT characteristics of pheochromocytoma: relevance for the evaluation of adrenal incidentaloma. J Clin Endocrinol Metab. 2019;104(2):312-318."},{"issue":"1","key":"bib9","series-title":"Eur J Endocrinol","first-page":"G1","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"189","author":"Fassnacht","year":"2023","unstructured":"Fassnacht MTsagarakis STerzolo M, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023;189(1):G1-G42."},{"issue":"1","key":"bib10","series-title":"Sci Rep","first-page":"2671","article-title":"Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours","volume":"12","author":"Araujo-Castro","year":"2022","unstructured":"Araujo-Castro MGarc\u00eda Centeno RRobles L\u00e1zaro C, et al. Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours. Sci Rep. 2022;12(1):2671."},{"issue":"6","key":"bib11","series-title":"J Am Coll Surg","first-page":"727","article-title":"Clinical spectrum of pheochromocytoma","volume":"209","author":"Guerrero","year":"2009","unstructured":"Guerrero MASchreinemakers JMJVriens MR, et al. Clinical spectrum of pheochromocytoma. J Am Coll Surg. 2009;209(6):727-732."},{"issue":"12","key":"bib12","series-title":"Eur Radiol","first-page":"2885","article-title":"Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function","volume":"18","author":"Jacques","year":"2008","unstructured":"Jacques AETSahdev ASandrasagara M, et al. Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function. Eur Radiol. 2008;18(12):2885-2892."},{"issue":"1","key":"bib13","series-title":"Curr Hypertens Rep","first-page":"12","article-title":"Severe paroxysmal hypertension (pseudopheochromocytoma)","volume":"10","author":"Mann","year":"2008","unstructured":"Mann SJ. Severe paroxysmal hypertension (pseudopheochromocytoma). Curr Hypertens Rep. 2008;10(1):12-18."},{"issue":"2","key":"bib14","series-title":"Endocrinol Metab Clin North Am","first-page":"279","article-title":"Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness","volume":"40","author":"Schwartz","year":"2011","unstructured":"Schwartz GL. Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness. Endocrinol Metab Clin North Am. 2011;40(2):279-294."},{"key":"bib15","series-title":"J Diabetes Metab Disord","first-page":"42","article-title":"Correction to: does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms","volume":"16","author":"Soltani","year":"2017","unstructured":"Soltani APourian MDavani BM. Correction to: does this patient have pheochromocytoma? A systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2017;16:42."},{"issue":"5","key":"bib16","series-title":"Ann Surg Oncol","first-page":"1444","article-title":"Inherited mutations in pheochromocytoma and paraganglioma: why all patients should be offered genetic testing","volume":"20","author":"Fishbein","year":"2013","unstructured":"Fishbein LMerrill SFraker DLCohen DLNathanson KL. Inherited mutations in pheochromocytoma and paraganglioma: why all patients should be offered genetic testing. Ann Surg Oncol. 2013;20(5):1444-1450."},{"issue":"3","key":"bib17","series-title":"AJR Am J Roentgenol","first-page":"636","article-title":"Diagnostic value of CT of chest, abdomen, and pelvis in patients with solitary and multiple brain lesions","volume":"214","author":"Rothman","year":"2020","unstructured":"Rothman RKWeinreb JZucconi WMalhotra A. Diagnostic value of CT of chest, abdomen, and pelvis in patients with solitary and multiple brain lesions. 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Br J Neurosurg. 2020;34(1):89-90."},{"issue":"3","key":"bib20","series-title":"Pharmacol Rev","first-page":"331","article-title":"Catecholamine metabolism: a contemporary view with implications for physiology and medicine","volume":"56","author":"Eisenhofer","year":"2004","unstructured":"Eisenhofer GKopin IJGoldstein DS. Catecholamine metabolism: a contemporary view with implications for physiology and medicine. Pharmacol Rev. 2004;56(3):331-349."},{"issue":"2","key":"bib21","series-title":"Endocrinol Metab Clin North Am","first-page":"295","article-title":"Hypertension in pheochromocytoma: characteristics and treatment","volume":"40","author":"Zuber","year":"2011","unstructured":"Zuber SMKantorovich VPacak K. Hypertension in pheochromocytoma: characteristics and treatment. Endocrinol Metab Clin North Am. 2011;40(2):295-311."},{"issue":"11","key":"bib22","series-title":"J Clin Endocrinol Metab","first-page":"4069","article-title":"Preoperative management of the pheochromocytoma patient","volume":"92","author":"Pacak","year":"2007","unstructured":"Pacak K. Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab. 2007;92(11):4069-4079."},{"issue":"5","key":"bib23","series-title":"Eur J Endocrinol","first-page":"951","article-title":"Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma","volume":"162","author":"Grouzmann","year":"2010","unstructured":"Grouzmann EDrouard-Troalen LBaudin E, et al. Diagnostic accuracy of free and total metanephrines in plasma and fractionated metanephrines in urine of patients with pheochromocytoma. Eur J Endocrinol. 2010;162(5):951-960."},{"issue":"3","key":"bib24","series-title":"Endocr J","first-page":"243","article-title":"Diagnostic accuracy of plasma free metanephrines in a seated position compared with 24-hour urinary metanephrines in the investigation of pheochromocytoma","volume":"62","author":"Kim","year":"2015","unstructured":"Kim HJLee JICho YY, et al. Diagnostic accuracy of plasma free metanephrines in a seated position compared with 24-hour urinary metanephrines in the investigation of pheochromocytoma. 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