The majority of patients with ganglioneuromas are asymptomatic. Some cases may present with sweating & hypertension (due to elevated catecholamine levels), abdominal cramping & diarrhea (secondary to synthesis of vasoactive intestinal peptide), and virilization in female patients (secondary to the presence of testosterone secreting Leydig cells in some cases). Although most ganglioneuromas produce catecholamines, urinary levels of catecholamines and their metabolites are elevated only with very large tumors. The photograph shows a 5.0 cm, well-circumscribed, firm, multinodular ganglioneuroma that arose in the adrenal (which is the site of involvement in about 20% of cases). Gross photograph courtesy of: Dr. Alfred Campbell, Spartanburg, South Carolina.