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822 a 380 ‐MBq intravenous bolus injection of the ra‐ diotracer. It involved whole ‐body scanning com‐ plemented by single ‐photon emission CT (SPECT) centered on the lower part of the head, abdomen, and pelvis. The examination was performed with the E.cam imaging equipment (Symbia E SPECT gamma camera, Siemens Healthineers, Hoffman Estates, Illinois, United States) and showed an in‐ creased heterogeneous uptake in the left adrenal gland (FIGURE 1C). Somatostatin ‐receptor scintig‐ raphy with 630 MBq of technetium 99m–labeled hydrazinonicotinyl ‐Tyr3 ‐octreotide gave similar results (FIGURE 1D). Based on imaging and biochemical evaluation, a suspicion of pheochromocytoma (PCC) was raised and the patient underwent a surgery af‐ ter 2 weeks of α ‐blocker intake. After that, the pa‐ thology report, verified by 2 well ‐trained pathol‐ ogists, revealed a 71 ‐mm adrenocortical carcino‐ ma (ACC), which stained negative for chromo‐ granin. Additional staining showed type 2 and 5 somatostatin receptors. Currently, 2 years after A 39 ‐year ‐old man with decompensated hyper‐ tension of up to 190/100 mm Hg was admitted to our department of endocrinology due to bilat‐ eral adrenal tumors revealed by ultrasonography and computed tomography (CT) of the abdomen. Noncontrast attenuation of the 63 ‐mm left ad‐ renal tumor was 35 HU, and its absolute (APW) and relative (RPW) percentage washouts at de‐ layed contrast ‐enhanced CT (delay, 10 min) were 60% and 30%, respectively, while for the small‐ er 23 ‐mm right adrenal tumor—98% and 77%, respectively. Chemical ‐shift magnetic resonance imaging (MRI) classified the left adrenal tumor as nonadenoma, as no signal loss occurred in the out ‐of ‐phase sequence (FIGURE 1A and 1B). Hypercortisolism and hyperaldosteronism were excluded, but the urinary levels of methoxycat‐ echolamines were 916 μg/24 h and 953 μg/24 h and remained in the upper limit of normal (up to 1000 μg/24 h). Iodine 123–labeled metaiodoben‐ zylguanidine (123I ‐MIBG) scintigraphy was car‐ ried out 6 hours after the patient had been given CLINICAL IMAGE

Adrenocortical carcinoma mimicking pheochromocytoma in 123-I-mIBG scintigraphy