PMC8011317_01
WB-CT scan at diagnosis of patient 1. Posterior mediastinal mass paravertebral to T9-T11 vertebral bodies (A), bilateral adrenal lesions (B) and periaortic and peri-common iliac artery lesion with an extensive encasement of this vessel (C).
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Whole body (WB)-CT scan revealed a posterior mediastinal mass (59x80 mm) paravertebral to T9-T11 vertebral bodies, bilateral hypervascular adrenal lesions (46x39 mm and 15.5 mm on the left and 80x110mm on the right) and a retroperitoneal periaortic and peri-common iliac artery lesion (135x185mm) with an extensive encasement of this vessel with a marked compression of the venous structures ( Figure 1 ).
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PMC8011317_04
Abdominal-CT (A, B) and MRI scan (C, D) before bilateral adrenalectomy: adrenal lesions on the right (A) and left (B) adrenal gland. Coronal in-phase (C) and out-of-phase (D) MRI images with no loss of signal in the mass.
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Over the years there was a progressive increase in the levels of plasma and urinary normetanephrines ( Table 3 ) and in the dimensions of the adrenal lesions (39x27mm on the right and 30x25mm and left adrenal gland on CT scan, both with enhanced contrast on T2 sequences and no signal intensity loss on the opposed-phased image on the MRI -  Figure 2 ).
PMC8011317_05
Abdominal-CT scan before left adrenalectomy showing a 17mm nodule on the left adrenal gland.
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From the age of 15 years old, he underwent annual screening with 24-hour urinary metanephrines and abdominal-CT every two years with both remaining normal until 2017 ( Table 4 ) when he presented evidence of norepinephrine hypersecretion and the abdominal-CT revealed on the left adrenal gland, a 17mm nodule with a contrast washout >60% with no other lesions seen on the contralateral gland ( Figure 3 ). 123I-MIBG scan revealed no abnormal uptake but the 68Ga- DOTA-NOC-PET scan documented an uptake on the left adrenal nodule.