PHEOCHROMOCYTOMA WITH METASTATIC LESION IN THE L4 VERTEBRA AND NEUROLOGICAL DEFICIT: CASE REPORT

FEOCROMOCITOMA COM LESÃO METASTÁTICA EM VÉRTEBRA L4 E DÉFICIT NEUROLÓGICO: RELATO DE CASO

FEOCROMOCITOMA CON LESIÓN METASTÁSICA EN LA VÉRTEBRA L4 Y DÉFICIT NEUROLÓGICO: REPORTE DE CASO

Objective:  To describe a rare single-stage surgical approach for vertebral metastatic pheochromocytoma in a middle-aged adult and review perioperative management strategies. Introduction Pheochromocytomas are rare neuroendocrine tumors (incidence 0.2–0.9/100,000/year), and about 10% develop metastases. Bone involvement— especially in the spine —is common in malignant cases. Spinal metastases from pheochromocytoma present hemodynamic challenges due to catecholamine secretion, and no consensus exists on treatment.

Case presentation:  A 38-year-old man with right adrenal pheochromocytoma on doxazosin reported severe low back pain and an L4 sensorimotor deficit. CT and MRI revealed an osteolytic lesion at L4 with epidural extension and additional metastatic foci at T11 and L1. Declining staged procedures, he underwent single-stage oblique anterolateral L4 corpectomy and fusion with an expandable cage. Preoperative preparation: α-blockade (doxazosin 2 mg/day), β-blockade, and fluoroscopic tumor embolization.

Discussion:  Vertebral metastasis from pheochromocytoma is rare, with male predominance and frequent involvement of the thoracic spine. Diagnosis is based on adrenergic symptoms, neurological deficits, elevated metanephrines, and imaging (CT/MRI). Biopsy is avoided due to bleeding risk. Surgical preparation includes α/β-adrenergic blockade and embolization. For management, en bloc resection with stabilization is preferred, with a challenging postoperative period requiring intensive care due to hemodynamic instability.

Conclusion:  Single-stage vertebral resection for metastatic pheochromocytoma is feasible when accompanied by adequate adrenergic blockade, preoperative embolization, and multidisciplinary support. Despite aggressive intervention, recurrence and neurological decline are common, underscoring the importance of early diagnosis and individualized perioperative planning. Level of Evidence IV; Case-Report.

Keywords:
Pheochromocytoma; Spinal Metastasis; Lumbosacral; Decompression; Therapeutic Embolization; Vertebral Corpectomy