101 Romanian JouRnal of medical PRactice – Vol. XV, no. 1 (70), 2020 Corresponding author: Lecturer Ana Valea, MD, PhD E-mail: ana74us@yahoo.com Flush after unilateral adrenalectomy Florica SANDRU 1,2 , Mihai Cristian DUMITRASCU 1,3 , Ana VALEA 4,5 , Simona Elena ALBU 1,3 , Anda DUMITRASCU 6 , Mara CARSOTE 1,6 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Elias Emergency University Hospital, Bucharest, Romania 3 Emergency University Hospital, Bucharest, Romania 4 Clinical County Hospital, Cluj-Napoca, Romania 5 “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania 6 “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania Abstract MEN (multiple endocrine neoplasia) type 2A syndrome, a rare autosomal dominant condition of RET proto-oncogene gain-of-function mutations mostly involves medullar thyroid cancer and pheocromocytoma (40-50%) while primary hyperparathyroidism has a less frequent incidence (based on genotype-phenotype correlations). We introduce a female case of MEN 2A syndrome with a particular evolution. This is a case report. A 38-old year female with family history of MEN2A syndrome, is currently experiencing transitory flush associated with mild palpitations (maximum 135/80 mmHg, respective 100-100 beats/minute). 6 years ago she had total thyroidectomy for medullar thyroid cancer (normal plasma metanephrines/norme- tanephrines and adrenal aspects at computed tomography). 2 years later she was detected with a unilateral pheocromocytoma. Laparoscopic left adrenalectomy was done. Currently, only an increase of plasma me- tanephrines is postive (twice normal upper limits), not plasma normetanephrines, nor urinary 24-hour metanephrines and normetanephrines. Computed tomography showed a right adrenal tumor of 1.3/2.3 cm and a left adrenal tumor of 1.12/0.76 cm. Whole body MIBG (meta-iodo-benzyl guanidine) scintigram was done and confirmed bilateral activity. Bilateral adrenalectomy is necessary. Flush after partial adrenalecto- my in patient with prior thyroidectomy for MEN2A syndrome - associated medullar thyroid cancer under- lines pheocromocytoma. The newly detected bilateral adrenal masses require an adequate differential diag- nosis of post-operatory aspect thus the usefulness of MIBG scintigram. Keywords: flush, pheocromocytoma, adrenalectomy Abbreviations i.v. = intravenous MEN = multiple endocrine neoplasia MIBG = meta-iodo-benzyl guanidine PTH = parathormone TSH = thyroid stimulating hormone INTRODUCTION MEN (multiple endocrine neoplasia) type 2A syndrome, a rare autosomal dominant condition of RET proto-oncogene gain-of-function mutations (variable penetrance, chromosome 10), involves thyroid cancer of medullar type and pheocromo- cytoma (40-50% of cases) and primary hyperpar- athyroidism with a less frequent incidence (based on genotype-phenotype correlations) (1). Specific Ref: Ro J Med Pract. 2020;15(1) DOI: 10.37897/RJMP.2020.1.19 Case presentations Article History: Received: 8 March 2020 Accepted: 19 March 2020